摘要
目的观察肝脏原发黏液性纤维肉瘤(MFS)的CT、MRI影像表现,探讨其影像学特征。方法回顾性分析2005年5月—2020年2月郑州人民医院经术后组织病理检查证实的5例肝脏原发MFS患者的CT、MRI影像资料。结果5例中病灶单发4例,多发1例。例3出现上腹部疼痛,余4例无明显不适。5例CT平扫显示肿块直径6.2~18.5 cm,中位直径13.5 cm;肿块均表现为较大囊实性不均匀低密度影,肿块内部可见条索状或云絮状分隔;例4边界清晰,另4例边界模糊;例1、例2边缘为浅分叶,例3、例4、例5为深分叶;例1、例3、例5突破肝包膜,侵及膈肌;除例4外肿瘤呈浸润性生长。MRI结果显示肿块含黏液的囊性成分均呈等T_(1)稍长T_(2)信号或稍短T_(1)等T_(2)信号,弥散加权成像呈稍高、高信号;部分呈长T_(1)、长T_(2)信号,弥散加权成像呈低信号;肿块周边可见实性结节,部分呈菜花状等T_(1)、等T_(2)信号,病灶内见条索样式或云絮状分隔呈等T_(1)等T_(2)信号,部分边界不清,弥散加权成像均呈高信号。CT及MRI增强扫描均显示肿块内囊液无强化,其内结节、分隔、囊壁呈渐进性轻中度强化;例3和例5 CT增强扫描动脉期可见瘤内弯曲小血管影。结论肝脏内出现较大囊实性肿块,肿块内含黏液成分,肿块内部周边可见结节及条索状、云絮状分隔,增强后结节、分隔及囊壁呈渐进性强化,肿瘤有浸润性生长特性,应考虑肝脏原发MFS可能,行多模态MRI扫描有助于黏液成分的诊断。
Objective To observe the CT and MRI findings of primary myxofibrosarcoma(MFS)of the liver and to investigate its imaging features.Methods The CT and MRI imaging data of 5 patients with postoperative histopathologically confirmed primary liver MFS in Zhengzhou People's Hospital from May 2005 to February 2020 were retrospectively analyzed.Results Among these 5 patients,MFS was single in 4 patients and multiple in 1.The clinical manifestations presented no obvious discomfort in 4 patients except upper abdominal pain in patient 3.On plain CT scan image,the tumors ranged from 6.2 to 18.5 cm in diameter,with a median diameter of 13.5 cm;all tumors showed huge uneven low density,with strip-shaped or cloud flocculent boundary;the boundary was unclear in all patients except patient 4;the margin was shallowly lobulated in patient 1 and 2,and deeply lobulated in patient 3,4 and 5;MFS broke though the liver capsule and invaded the diaphragm in patient 1,3 and 5.MFS was in infiltrating growth in all patients except patient 4.The cystic component in tumors revealed equal T_(1) signal and slightly long T_(2) signal,or slightly short T_(1)signal and equal T_(2) signal on MRI,and slightly high or high signal intensity on DWI;part of cystic component revealed long T_(1) and T_(2) signals,and low signal intensity on DWI;solid nodules were seen around the tumor,and some of them were in cauliflower shape,showing equal T_(1) and T_(2) signals;strip-shaped or cloud flocculent boundary showed equal T_(1)and T_(2) signals with unclear partial boundary,and high signal on DWI.CT and MRI enhanced scanning showed no enhancement of the cystic fluid in the tumor,and showed mild to moderate progressive enhancement in the nodules,septa and cystic walls.MFS of the liver showed curved small vessels in arterial phase in patient 3 and 5 on enhanced CT scan.Conclusions MFS should be diagnosed when there is a huge cystic-solid lesion in the liver,with mucinous components in the lesion,the nodules,strip-shaped or cloud flocculent boundaries are found inside the lesion,mild to moderate progressive enhancement is revealed in the nodules,septa and cystic walls after enhancement,and the tumor has the feature of infiltrating growth.Multi-modal MRI scan contributes to the diagnosis of fluid component.
作者
祁佩红
张斯佳
窦社伟
李四保
朱绍成
刘志敏
QI Peihong;ZHANG Sijia;DOU Shewei;LI Sibao;ZHU Shaocheng;LIU Zhimin(Department of Medical Imaging,Zhengzhou People's Hospital,the Fifth Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou,Henan 450053,China;Department of Medical Imaging,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Pediatrics,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)
出处
《中华实用诊断与治疗杂志》
2023年第9期870-873,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划项目(2018020831)
河南省二○二一年科技发展计划(212102310729)。
