摘要
目的探讨侵袭性血管粘液瘤(AAM)CT、MRI影像学特征及术前评估。方法回顾性分析2010年1月至2020年3月首都医科大学附属北京朝阳医院2个院区(本部及西区)收治的经手术病理证实的AAM患者资料共14例,14例患者术前均行盆腔及盆底MR平扫及增强扫描,8例行腹盆部CT平扫。观察肿瘤的影像特征、血供情况及与盆底结构间的关系,同时对肿瘤所致会阴疝进行影像学测量。手术切除后行常规病理学检查。结果(1)肿瘤体积较大,最大径线平均(12.25±5.64)cm。(2)10例(71.4%)病变跨越尿生殖膈及盆膈疝入会阴区,形成盆腔、会阴、外阴联合肿块,疝口平均(21.45±18.99)cm^(2),疝囊平均(604.51±653.21)cm^(3)。(3)CT平扫低密度及MRT2高信号是病变富含黏液基质的特征性征象;T2WI及T1WI增强扫描病变内旋涡样及分层样改变是AAM较为特异的影像征象,提示病变富含成束走行胶原纤维及血管结构;DWI、ADC图像肿瘤均呈现高信号,ADC值较高,为(2.04±0.27)×10^(-3) cm/s,提示肿瘤无明显弥散受限。(4)肿块包膜完整9例,包膜局部不完整且与周围组织分界不清的5例。(5)10例盆腔、会阴、外阴联合肿块为多支动脉供血,主要为髂内动脉脏支、壁支分支,其中以阴部内动脉(10/10)供血最为常见,外阴区、腹股沟区肿块多为单支动脉供血。结论AAM影像学表现具有一定特征性,不仅可以在鉴别诊断上提供信息,还可以细致评估肿瘤的供血及与周围组织器官的关系,同时对于肿瘤所致会阴疝进行准确的测量,为手术方案选择提供依据。
Objective To investigate the CT and MRI imaging features of aggressive angiomyxoma(AAM)and to provide evidence for differential diagnosis.To explore the important value of imaging examination in preoperative evaluation.Methods 14 patients with pathologically confirmed AAM had CT and/or MRI examination.14 patients underwent plain and contrast enhanced MRI of pelvic cavity and pelvic floor before operation.8 patients underwent plain CT scan of abdominal and pelvic cavity.The imaging features,blood supply and the relationship with pelvic floor structure were observed.At the same time,perineal hernia caused by tumor was measured.Routine pathological examination was performed after operation.Results(1)The masses were large,with a mean maximum diameter of(12.25±5.64)cm.(2)The lesions crossed the urogenital septum and pelvic septum and herniated into the perineal area in 10 cases(71.4%).(3)The lesions were hypodensity on the plain CT and hyperintense on T2WI.It was a characteristic sign of a lesion rich in mucinous matrix.The characteristic“swirled”or“layered”appearance was observed in T2WI and contrast enhanced T1WI.It is suggested that there are bundles of collagen fibers and vascular structures in the lesions.DWI and ADC images showed high signal,ADC value was(2.04±0.27)×10^(-3) cm/s.It is suggested that there is no limited diffusion in the tumor.(4)The capsule was complete in 9 cases and incomplete in 5 cases.(5)The masses involved the pelvis,perineum and vulva,which were supplied by multiple arteries.The internal pudendal artery was the most common.The masses in vulva and inguinal area were mostly supplied by single artery.Conclusion AAM exhibits characteristic CT and MRI features.It can not only provide information in differential diagnosis,but also meticulously assess the blood supply of the tumor and its relationship with the surrounding tissues and organs,as well as provide accurate measurement for perineal hernia caused by the tumor,which can provide a basis for surgical plan selection.
作者
潘振宇
李坤
裴晓娇
闫玉昌
龚翔
都雪朝
炼宇飞
Pan Zhenyu;Li Kun;Pei Xiaojiao;Yan Yuchang;Gong Xiang;Du Xuechao;Lian Yufei(Department of Radiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100024,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2021年第4期342-346,共5页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
