韧带样型纤维瘤病的CT和MR诊断

目的本文分析韧带样型纤维瘤病CT和MR平扫和增强特征,探讨影像学诊断价值。方法回顾性分析12例经手术病理证实的韧带样型纤维瘤病病例,术前经MR检查9例,CT检查3例。MR检查序列包括SET1WI、FSET2WI、STIR、SPGR平扫和多期的MR动态增强。所有病例影像资料均经3名高年资医师分别阅片,分别确定病变浸润范围、信号特征和强化程度等,并与手术病理对照。结果12例韧带样型纤维瘤病病例中,腹部外7例(颈部2,肩1,四肢4),腹壁型3例(腹壁肌肉),腹内型2例(肠系膜1,腹膜后1)。肿瘤直径3.7～21.8cm,<5cm3例,5～10cm7例,>10cm2例,平均7.2cm。浸润性生长9例,膨胀生长3例。密度或信号相对均匀5例,不均匀7例。9例MR检查病例中,SET1WI呈等信号5例,略高信号4例。所有病例T2WI信号略高于肌肉,STIR为高信号,各序列常见低信号致密胶原纤维成分。无论肿瘤大小,STIR都清楚显示肿瘤边缘和境界。5例MR动态增强病例中,动脉期明显强化4例,显著强化1例;门脉期强化程度与动脉期相仿,强化趋于均匀。3例CT检查病例,肿瘤密度与肌肉相仿,密度均匀,形态不规则,境界欠清楚。1例病灶内可见形态正常的血管影。结论韧带样型纤维瘤病形态多不规则,信号不均匀,境界模糊不清,MRT2WI为略高信号,STIR为高信号,强化显著,病灶内常见致密胶原纤维形成低信号。CT和MR特征明显,多数病变术前可以诊断。

Desmoid-type fibromatoses: the findings of dynamic CT and MR

Objective Exploring the dynamic CT and MR findings of desmoid-type fibromatoses and evaluating it's clinical value.Methods All 12 cases of patients with desmoid-type fibromatoses confirmed by surgical pathology underwent CT or MR plain scanning and multi-phases dynamic enhancement scanning before operation,the CT and MR data were reviewed and analysed retrospectively in comparison with surgical and pathological results.Results Seven of 12 aggressive fibromatoses were located in extra-abdominal(cervical part 2,the shoulder 1,the four limbs 4),3 in abdominal in abdominal wall muscles and 2 in intra-abdominal cavity(mesentery connective tissue 1,retroperitoneum 1),respectively.The average tumor size was 7.2 cm(range,3.7-21.8 cm)with 3 cases <5.0 cm,7 cases 5.0-10.0 cm and 2 cases >10 cm,the tumor presented infiltrative features in 9 cases,expand features in 3 cases and appeared as a solid mass with an irregular or lobulated contour and ill-defined borders.On MRI,homogeneous isointensity or mild hyperintensity on T1-weighted images,heterogenous mild hyperintensity on T2-weighted and obviously hyperintense on STIR images were seen,and some cases showed low signal on all pulse sequences.All lesions showed intense enhancement on postcontrast.Conclusion The CT and MR features of desmoid-type fibromatoses are obvious,such as irregular or lobulated contour,ill-defined borders,mild hyperintensity on T2-weighted,hyperintense on STIR,low signal on all pulse sequences and intense enhancement,most of them can be diagnosed before operation.