摘要
目的分析胸部不同部位原发及复发硬纤维瘤的常规MRI各序列特征及ADC值和动态增强MRI时间信号强度曲线(TIC)类型的定量表现。方法搜集2017年7月至2020年12月间20例经手术病理证实的胸部硬纤维瘤患者。均行常规MRI和动态增强MRI检查。基于标准MRI影像,根据手术史,进行原发及复发病灶的分组,分析病灶的大小、位置、边缘、形态、信号特点、单侧/双侧、邻近组织结构受累情况,重点记录肿瘤的信号强度、强化特点,通过后处理软件观察肿瘤的强化模式,判别TIC类型,测量病灶内的ADC值,并与术后病理进行对照,探讨术前影像诊断与术后诊断的误诊原因及影像-病理基础。结果受检者的平均年龄是(43.07±16.23)岁(17~68岁),男女比例为0.33∶1,平均大小约71.9 mm×44.3 mm×71.7 mm。发生于胸壁18例(含起源于胸膜外间隙筋膜的胸膜外区局限者8例,起源于胸膜外间隙朝胸腔生长者3例,起源于胸膜外间隙跨胸腔生长者3例,前胸壁乳腺后肌间区2例,侧胸壁含肩/腋窝区2例);颈胸交界锁骨区1例;纵隔区1例。肿瘤边缘清晰15例,边界不清晰5例。形态呈分叶状8例,类椭圆形8例,不规则4例。病灶在T_(1)WI均显示等信号,在T_(2)WI图像上呈等偏高信号。均匀强化15例,不均匀强化5例,可观测到强化中内部低信号带。单侧19例,双侧1例;胸膜增厚15例(含胸腔积液1例),肺侵犯1例(复发伴4R组淋巴结累及),邻近骨质侵犯9例,邻近软组织侵犯12例,神经血管侵犯1例。14例初诊首发,6例复诊术后复发(含1例初诊复发)。20例TIC分布均呈Ⅰ型(持续上升型)。原发组14例ADC均值为(1.66±0.41)×10^(-3)mm^(2)/s,复发组6例ADC均值为(1.39±0.05)×10^(-3)mm^(2)/s。结论常规MRI结合ADC值是胸部硬纤维瘤的重要检查手段,动态增强MRI呈持续上升的TIC分布是其重要特征,定量分析结合形态学有助于提高定性诊断效能。复发于原位置居多并向周围延伸且范围不定,通常信号不均,可合并出现淋巴结转移。
Objective To describe the sequence characteristics of conventional MRI of desmoid tumors at different locations on the chest,primary and recurrent lesions,the ADC values of DWI images,and the quantitative manifestations of the dynamic enhanced MR time signal intensity curve(TIC)type.Methods From July 2017 to December 2020,20 patients with thoracic desmoid tumor confirmed by surgery and pathology were retrospectively analyzed.All patients underwent conventional MRI and dynamic contrast-enhanced MRI(n/20).Based on the standard MRI images,the primary and recurrent lesions were grouped according to the surgical history.The size,location,margin,shape,signalcharacteristics,unilateral/bilateral,adjacentpleura,lung,adjacentbone,such as sternum/rib/thoracic vertebrae and chest wall soft tissue and neurovascular involvement were analyzed.The signal intensity and enhancement characteristics of the tumor were recorded.The enhancement pattern of the tumor was observed by post-processing software.The TIC type was differentiated.The ADC value in the lesion was measured and compared with the postoperative pathology.The causes of misdiagnosis and imaging pathological basis of preoperative and postoperative diagnosis were discussed.Results The average age of the subjects was(43.07±16.23)years old,ranging from 17 to 68 years old,with a male to female ratio of 0.33:1.The average size is about 71.9.The most common site was the chest wall in 18 cases(including 8 cases of limited extrapleural area originating from the extrapleural space(EPS),3 cases of EPS growing towards the chest,3 cases of EPS growing across the chest,2 cases of anterior chest wall and posterior breast intermuscular area,and 2 cases of lateral chest wall with shoulder/axillary area);Secondly,the clavicular region of cervicothoracic junction was found in 1 case;The most rare case was in the mediastinum.Themargin of the tumor was clear in 15 cases and unclear in 5 cases.The shape was lobulated in 8 cases,oval in 8 cases and irregular in 4 cases.The lesions showed equal signal intensity on T1 weighted images,and equal high signal intensity on T2 weighted images.There were 15 cases of homogeneous enhancement and 5 cases of inhomogeneous enhancement.19 cases were unilateral and 1 case bilateral;Pleural thickening was found in 15 cases(including 1 case of pleural effusion),lung involvement in 1 case(recurrence with 4R group lymph node involvement),adjacent bone involvement in 9 cases,adjacent soft tissue involvement in 12 cases,neurovascular involvement in 1 case.14 cases were initial diagnosis,6 cases recurred after follow-up(including 1 case of recurrence).Tic curve distribution of 20 cases showed type I continuous growth type.The mean ADC was(1.66±41)×10^(-3)mm^(2)/s,and the mean ADC of recurrence group was(1.39±0.05)×10^(-3)mm^(2)/s.Conclusion Conventional MRI combined with apparent diffusion coefficient is an important auxiliary means of thoracic desmoid tumor.The continuously rising tic curve distribution of dynamic enhanced MRI is an important feature.Quantitative analysis combined with morphology can help to improve the qualitative diagnosis efficiency.Most of the patients recur in the original location and extend to the surrounding area with uncertain range.The signal is usually uneven and lymph node metastasis can be combined.
作者
马永红
王晓泉
叶晓丹
于红
MA Yonghong;WANG Xiaoquan;YE Xiaodan(Department of Radiology,Shanghai Chest Hospital,Shanghai Jiao Tong University,P.R.China)
出处
《临床放射学杂志》
北大核心
2021年第11期2123-2128,共6页
Journal of Clinical Radiology
基金
国家自然基金面上项目(编号:82071873)。
关键词
胸部硬纤维瘤
磁共振成像
定量
胸膜外间隙
Thoracic desmoid tumor
Magnetic resonance imaging
Quantitative analysis
Extrapleural space(EPS)
