摘要
目的 探讨多层螺旋CT(MSCT)、MRI在诊断侵袭性血管粘液瘤(AAM)中价值和临床术后病理对照。方法搜集经手术后病理证实的12例AAM,回顾性分析AAM的CT、MRI影像学表现及其特点,包括肿瘤大小、形态、好发部位、影像特点、生物学行为(生长方式、与周围结构的关系)。结果 12例AAM患者中,女性11例,男性1例,年龄26~68岁,平均年龄46.3岁;盆腔5例,外阴3例,会阴2例,臀部1例,病灶广泛无法确定具体部位1例,4例跨区生长;球形、椭圆形、哑铃状8例,不规则形状4例;CT平扫9例呈较大或巨大囊实性肿块,8例呈较均质略低密度灶,密度与肌肉相近或略低,12例动脉期较明显强化,边缘强化为著,7例其内“散在细条状强化”,9例静脉期、实质期继续强化呈“环状、弧样”,12例瘤体边缘呈血管样强化。MRI:8例T1WI一般呈略低于同层肌肉信号影,10例T2WI呈略高于同层肌肉信号影,10例肿瘤快速强化、且较均匀,出现特征性“漩涡状”征象,与周围结构关系分界不清;12例患者均行外科手术治疗,其中4例术前行DSA检查及栓塞治疗,占比33.4%,起到缩小肿瘤,减少出血,降低手术切除难度的作用;有5例术后定期随访,提示术后复发征象,复发率为41.7%。结论 MSCT应用方便快捷,虽MRI检查时间长,但MRI可以冠、矢状多方位扫描,还能分析肿瘤成分,二者结合,能更清晰显示肿瘤部位、大小、形态、内部结构、范围及与邻近结构的解剖关系,尤其MRI特征性“漩涡状”表现,对诊断AAM敏感性和特异性较高,为临床提供术前诊断/术式的选择及术后随访的评估具有重要的参考作用。
Objective To study the value of multi-slice spiral CT (MSCT) and MRI in the diagnosis of invasive vascular myxoma (AAM) and, meanwhile, to compare the data with postoperative pathologic findings. Methods In our hospital and two other hospitals, 12 cases of AAM, which were confirmed by postoperative pathology, were collected, and the CT and MRI imaging features of AAM, in terms of tumor size, shape, good location, imaging characteristics, and biological behavior, i.e., the relationship between growth mode and surrounding structure, were analyzed retrospectively. Results Of the 12 AAM patients, 11 were female and 1 was male, aged 26~68, with an average of 46.3 years old. 5 cases occurred in pelvic cavity, 3 in vulva, 2 in perineum, and 1 in hips. One case was incapable of identifying the specific part due to the extensive lesions and 4 exhibited the interregional growth. The lesions appeared as spherical, oval or dumbbell-shape in 8 cases and irregular shape in 4 cases. Plain CT scan showed that 9 cases presented with large or huge cystic mass, 8 exhibited the focus with homogeneous low density, similar to or slightly low of the muscle tissue. At the arterial phase 12 cases were obviously strengthened, especially the edge. 7 cases showed the scattered thin stripe enhancement. At the venous phase, 9 cases showed enhancement in ringlike or arc shape, 12 cases presented with vascular like enhancement on the edge of the tumor. MRI showed T 1WI signal in 8 cases was slightly lower than the muscular signal of the same layer, and T 2WI signal in 10 cases was slightly higher than that of the same layer muscle, the tumor was enhanced quickly and evenly, and the characteristic signs as "whirlpool" appeared. 12 patients were treated with surgical treatment, of which 4 cases were treated with DSA angiography and embolization, accounting for 33.4%. Such treatment reduced the tumor size, decreased bleeding, and lowered difficulty of surgical excision. 5 cases were followed up regularly and the recurrence rate was 41.7%. Conclusi
作者
陈善锡
颜森森
林一锱
严志汉
候波
高源统
张雷
CHEN Shanxi;YAN Sensen;LIN Yizi;YAN Zhihan;HOU Bo;GAO Yuantong;ZHANG Lei(Department of Radiology, The Third Affiliated Hospital of Wenzhou Medical University Ruian People's Hospital, Ruian 325200, P.R.China;Department of Radiology, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou 325000, P.R.China;Image Center of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100000, P.R.China)
出处
《医学影像学杂志》
2019年第8期1310-1313,共4页
Journal of Medical Imaging
基金
浙江省科学技术厅省级公益性技术应用研究计划项目(编号:2015C33287)
