孤立性纤维性肿瘤的临床、病理和影像学表现

摘要

Purpose:To improve the knowledge of solitary fibrous tumors (SFTs) on clinic,pathology and imageology.Methods:MRI/CT appearances of 19 patients with SFTs confirmed by pathology were analyzed retrospectively and the relevant literatures were reviewed.Sixteen patients were performed CT examination,including 10 cases of routine enhancement scans and 4 cases of dynamic enhancement scans and 2 cases of plain scans.Both plain MRI scans and enhancement MRI scans were performed in 7 patients,including 1case of dynamic enhancement scan.Results:Eight patients were male and 12 patients were female.Of all the patients,80％ were above 50 years old.Of all the lesions,40％ were located in the pleura,30％ were located in the abdominal-pelvic cavity.Four lesions were malignant in histology.On CT,most of the tumors were lobular and solid; the margins of most tumors were smooth; 1 case of tumor was cystic and some tumors had calcification (most calcification was distributed in the periphery of tumors and was punctate/commashaped); and most of the lesions demonstrated heterogeneous enhancement (whirlpool like or patch like or in "geographic pattern"); and some of the tumors were showed with "collateral feeding vessels".On MRI,most tumors were lobular in shape and with well-defined margins; most tumors were solid and no tumor was cystic; all the tumors demonstrated heterogeneous enhancement; most tumors showed mainly iso-intensity on T2WI and were mixed with slightly hypo-intensity.The tumors showed early and persistent enhancement in 4cases of CT and 1 case of MRI.Conclusion:SFTs are rare mesenchymal tumors that usually occurred in the patients over 50 years of age.They are found almost in every part of human body.SFTs in different location have similar imaging appearances,most of them are solid and very few of them are cystic.Given their unpredictable biologic behavior with reports of recurrent or metastatic disease,complete surgical excision and long-term imaging follow-up for them is recommended.%目的:提高对孤立性纤维性肿瘤的临床、病理和影像学表现的认识.方法:收集20例经病理确诊的孤立性纤维性肿瘤.16例行CT检查,其中10例平扫和常规增强；4例平扫和三期增强；2例仅平扫.7例行MR平扫和增强,其中1例行动态增强扫描.结果:男8例女12例,80％在50岁以上.多位于胸膜(8/20),其次为腹盆腔(6/20).4例为组织学恶性、其中3例大于l0cm.肿瘤在CT[上多数轮廓分叶(15/16)；多边界清楚(13/16)；多以实性为主(10/16)；可伴钙化(6/16)、多位于肿瘤边缘且大多呈斑点/短弧形；14例增强者均呈不均匀强化、4例动态增强者均早期并持续强化；非囊变/坏死的低密度呈现旋涡状(5/14)、斑片状(5/14)、地图样(4/14);可见滋养血管征(5/16).在MRI上肿瘤轮廓多分叶(6/7)；多边界清楚(4/7)；多以实性为主(6/7)；T2WI上肿瘤实质均夹杂低信号；均呈不均匀强化、其中1例动态增强者呈早期并持续强化.结论:孤立性纤维性肿瘤发病部位广泛,50岁以上好发,各部位肿瘤的影像学表现相似,多为实性,最终靠病理确诊,完全切除是决定预后的重要指标,术后长期影像学随访必不可少.