头颈部孤立性纤维瘤的影像学表现

目的：探讨头颈部孤立性纤维瘤(SFT)的影像特征,提高对该病的认识。方法回顾性分析10例经手术病理证实的头颈部 SFT 患者的 CT 和 MR 表现。10例均行 CT 平扫及双期增强扫描、2例行 MR 检查。结果10例病灶均表现为孤立的肿块,最大径20~115 mm,中位最大径约35.5 mm。肿瘤发生于眼眶2例、鼻腔鼻窦4例,腮腺、面颊、锁骨上区及枕部各1例。病变边界清楚8例、模糊2例,呈椭圆形7例,分叶状3例。CT 平扫呈等或稍低密度,其中4例密度均匀,6例密度不均匀(2例见多发囊变区,1例见结节状钙化灶)。增强后9例呈明显均匀(n=3)或不均匀(n=6)强化,1例呈轻度均匀强化。CT 双期增强强化模式包括快速强化缓慢廓清8例、快速强化快速廓清1例和延迟强化1例。与脑实质相比,T1 WI 呈均匀等信号1例,等、低混杂信号1例；T2 WI 呈均匀等信号1例,等、高混杂信号(多发囊变)1例；增强后分别呈均匀和不均匀显著强化。结论头颈部不均匀的富血供肿瘤要考虑到 SFT 的可能。瘤体 T2 WI 与脑实质相比呈等或稍低信号,CT 增强扫描明显强化,双期增强呈快速强化缓慢廓清的强化模式可能是有诊断价值的影像特点。

Imaging features of solitary fibrous tumors in the head and neck

Objective To explore the imaging features of solitary fibrous tumor (SFT)in the head and neck.Methods The CT and MR findings of 10 patients with SFT in the head and neck confirmed by hsitopathology were analyzed retrospectively.All patients underwent CT (including contrast-enhanced dual-phase CT),and MR imaging was obtained in 2 patients.Results All 10 lesions were found as solitary masses ranging in maximum diameter from 20 to 1 1 5 mm (average 35.5 mm),with the location in the orbit (2 cases),nasal cavity and nasal sinuses (4 cases),parotid gland (1 case),supraclavicular region (1 case),subcutaneous tissue of the maxillofacial (1 case)and occipital region (1 case).The lesions showed elliptic shape in 7 cases and lobulated configuration in 3 cases.The majority (8/10 )of lesions demonstrated well-defined margin.The lesions on CT imaging were isodensity or low density, homogeneous density in 4 cases and inhomogeneous density in 6 cases,cystic changes in 2 cases,calcification in 1 case.9 lesions showed strongly homogeneous (n=3)or inhomogeneous (n=6)enhancement,1 lesion showed mildly homogeneous enhancement on contrast-enhanced CT imaging.On dual-phase enhanced CT,8 patients exhibited a rapidly enhancing and slow washout pattern,1 patient exhibited a rapidly enhancing and rapid washout pattern,and 1 patient exhibited delayed enhancement.The lesions showed homogeneous isointense relative to gray matter on T1 WI in 1 patient,mixed isointense and hypointense in 1 patient.On T2 WI,the lesion showed isointense signal in 1 patient,and heterogeneous mixed isointense and hyperintense signal in another.2 lesions demonstrated markedly homogeneous and inhomogeneous enhancement respectively.Conclusion Solitary fibrous tumors shall be considered in cases of inhomogeneous hypervascular tumors in the head and neck.Compared with the gray matter,isointense or mildly hyperintense signal on T2 WI, marked enhancement on contrast-enhanced CT,and a rapidly enhancing and slow washout pattern on dual-phase enhanced CT may be valuable imaging features of SFT.