22例滑膜肉瘤的影像学分析

目的分析滑膜肉瘤的CT和MRI表现及其相关临床病理特征,探讨CT和MRI对滑膜肉瘤的诊断价值。方法回顾性分析22例经手术病理证实的滑膜肉瘤患者的临床和影像学资料。结果肿瘤多位于四肢关节附近的深部软组织内,呈"钻孔样或包绕样"生长趋势;病灶呈圆形或卵圆形,部分可有分叶,轮廓多较清晰。肿瘤体积一般较大,22例病灶最大直径为3.1cm-13.4cm,平均7.1cm。由于常合并坏死、囊变、出血等,病灶密度或信号多不均匀。CT平扫多呈等或稍低密度的软组织肿块,6例病灶内可见坏死区,2例病灶合并有钙化。MRI平扫肿瘤实性部分T1WI多呈等或稍低信号,5例病灶内部T1WI可见高信号区,提示合并出血;T2WI病灶信号较混杂,部分病灶内部可见分隔样低信号影;压脂序列肿瘤显示较好,呈明显高信号;3例伴有邻近的骨质破坏。增强CT和MRI表现相仿,多呈明显不均匀强化。结论滑膜肉瘤的影像学表现具有一定特征性,CT和MRI综合评价有助于提高滑膜肉瘤的的诊断准确性,确诊仍需依靠病理学检查。

Imaging analysis of 22 Synovial Sarcoma

Abstact]Objective According to the imaging findings and its related clinical and pathologic characters of synovial sarcoma (SS), to explore the diagnostic value of the CT and MRI.Methods The Clinical and imaging data of 22 SS confirmed by pathology were retrospectively analyzed.Results Most of the SS located in the deep soft tissue near the extremities and joints, showing "drilling or encircling -like" growth trend. They were generally round, oval or lobulated in shape and well-defined. The tumors were generally larger, the maximum diameter of the 22 cases was 3.1cm-13.4cm and the average was 7.1cm. The density or signal was heterogeneous as the tumors were often with necrosis or cystic areas and hemorrhage. On CT, most lesions appeared soft-tissue mass with attenuation similar to or slightly lower than that of muscle, 6 cases with the necrosis aera and 2 cases with calcification inside it. On T1WI of the MRI, the solid part of the tumors usually presented iso- or hypo-intense. 5 cases showed patch hyperintense area, which suggested the hemorrhage. On T2WI, the signal was heterogeneous, some cases with hypointense septa among the lesions. The tumors were obviously high signal in the fat suppression sequence. 3 cases appeared destruction of the adjacent bone. After contrast, the performance of CT and MRI was similar, most of the tumors showed obviously heterogeneous enhancement.Conclusion SS has some special imaging manifestation, combining CT and MRI can improve the diagnostic accuracy of SS, however, pathology is still mandatory to confirm the diagnosis.