髋周侵袭性软组织肿瘤的MRI诊断及病理对照

目的总结髋周的侵袭性软组织肿瘤的MRI表现，探讨MRI对髋周软组织肿瘤术前诊断的价值。方法经手术病理证实的19例髋周侵袭性软组织肿瘤，男12例，女7例，平均年龄45．2岁。所有病例均行常规MRI平扫及Gd—DTPA增强扫描，分析其MR表现。结果侵袭性纤维瘤病5例，恶性纤维组织细胞瘤5例，滑膜肉瘤2例，脂肪肉瘤4例，淋巴瘤1例，原始神经外胚层肿瘤1例，转移瘤1例。侵袭性纤维瘤病边界不清，T1WI呈等信号，T2WI呈稍高信号，其内见星芒状低信号带。增强扫描明显均匀强化。恶性纤维组织细胞瘤、脂肪肉瘤T1WI信号呈等或稍低信号，T2WI呈稍高信号或高信号，其内见点状或片状明显高信号区。病灶周围肌肉常有水肿信号。增强扫描肿瘤明显不均匀强化。滑膜肉瘤内见液平，肿块呈多结节样。原始神经外胚层肿瘤、淋巴瘤与转移瘤周围肌肉水肿显著。结论MRI对髋周软组织肿瘤术前诊断有较高的参考价值。

Analysis of MRI appearance of aggressive soft tissue tumor in hip joint region: compared with pathology

Objective To analyze the MRI appearance of soft tissue tumor in hip joint region, and compare it with pathological features. Methods MR appearance of 19 soft tissue tumor in hip joint region were retrospectively analyzed, including 12 male and 7 female, 45.2 years averaged. All patients had taken common MR scanning and Gd-DTPA contrast scanning. Results There was 5 aggressive fibromatosis, 5 malignant fibrous histiocytoma, 2 synovial sarcoma, 4 liposarcoma, 1 lymphoma, 1 primitive neuroectodermal tumor and 1 metastatic tumor. Of 19 cases, 13 with hemorrhage and necrosis, 14 with peripheral edema, nerve and vessel involved in 11. Aggressive fibromatosis appeared as isointensity or hypointensity on T1WI, and moderate hyperintensity on T2WI with low signal inside. Malignant tumor were mostly ill-defined. After contrast scanning, tumors enhanced apparently. Malignant fibrous histiocytoma showed isointensity and heter-hypointensity on T1WI, and heter-hyperintensity on T2WI. Necrosis and hemorrhage occurred. All cases showed strong enhancement, except for the areas of necrosis. Edema around tumor can be seen in most cases. Conclusion MRI can demonstrate the form and internal and peripheral structure of soft tissue tumor in hip joint region, and can contribute to the diagnosis before operation.