CAJ | 학술논문

目的：探讨应用MRI评估肢体软组织侵袭性纤维瘤病（ AF ）组织病理特征的意义。方法分析20例AF的MRI和组织病理学表现；比较AF瘤内不同MRI信号区的T1 WI、T2 WI信号及强化程度，观察瘤内不同MRI信号区的HE染色与Masson三色染色表现。对所获数据进行配对t检验。结果（1）AF起源于骨骼肌（19／20），边缘分叶（20／20），呈浸润性生长（20／20）；（2）三维动态对比增强血管造影（3D－DCEMRA）显示瘤体边缘少量爪状新生动脉（7／7）和轻度肿瘤染色（7／7）；（3）根据MRI表现，20例AF分为Ⅰ区、Ⅱ区2种结构。Ⅰ区，在T1 WI、T2 WI上为极低信号，增强扫描不强化；Ⅱ区， T1WI 上呈等信号或稍高信号，T2WI 上呈稍高信号，增强后显著强化；（4）Ⅰ区的T1WI、T2WI信号及强化程度分别为（0．10±0．02）、（0．24±0．03）和（5．22±0．42）％，Ⅱ区依次分别为（0．79±0．04）、（3．05±0．08）和（151．5±8．61）％，两者的T1WI信号（t＝67．37）、T2WI信号（t＝196．56）及强化程度之间（t＝76．62）的差异均有统计学意义（P值均＜0．01）；（5）AF由成纤维细胞、纤维细胞和胶原纤维束组成。 Masson三色染色上，Ⅰ区呈蓝色，为成熟的胶原纤维束；Ⅱ区不染色，主要成分为成纤维细胞与纤维细胞。结论 AF的Ⅰ区、Ⅱ区结构在MRI上有明显特征，MRI能准确反映AF的组织病理与生物学行为特征。
목적：탐토응용MRI평고지체연조직침습성섬유류병（ AF ）조직병리특정적의의。방법분석20례AF적MRI화조직병이학표현；비교AF류내불동MRI신호구적T1 WI、T2 WI신호급강화정도，관찰류내불동MRI신호구적HE염색여Masson삼색염색표현。대소획수거진행배대t검험。결과（1）AF기원우골격기（19／20），변연분협（20／20），정침윤성생장（20／20）；（2）삼유동태대비증강혈관조영（3D－DCEMRA）현시류체변연소량조상신생동맥（7／7）화경도종류염색（7／7）；（3）근거MRI표현，20례AF분위Ⅰ구、Ⅱ구2충결구。Ⅰ구，재T1 WI、T2 WI상위겁저신호，증강소묘불강화；Ⅱ구， T1WI 상정등신호혹초고신호，T2WI 상정초고신호，증강후현저강화；（4）Ⅰ구적T1WI、T2WI신호급강화정도분별위（0．10±0．02）、（0．24±0．03）화（5．22±0．42）％，Ⅱ구의차분별위（0．79±0．04）、（3．05±0．08）화（151．5±8．61）％，량자적T1WI신호（t＝67．37）、T2WI신호（t＝196．56）급강화정도지간（t＝76．62）적차이균유통계학의의（P치균＜0．01）；（5）AF유성섬유세포、섬유세포화효원섬유속조성。 Masson삼색염색상，Ⅰ구정람색，위성숙적효원섬유속；Ⅱ구불염색，주요성분위성섬유세포여섬유세포。결론 AF적Ⅰ구、Ⅱ구결구재MRI상유명현특정，MRI능준학반영AF적조직병리여생물학행위특정。
Objective To assess the value of using MRI to evaluate the histopathological characteristic of limb soft-tissue aggressive fibromatosis ( AF ) .Methods The MRI findings and histopathological data of 20 patients with AF were obtained and analyzed. The difference between the different signal regions in AF were compared of signal intensity in T1-weighted images, T2-weighted images and degree of enhancement.The data were processed with paired t test.The histopathology of different signal regions was observed in 6 cases on HE stain and Masson trichromic stain of AF specimen.Results (1) AF predominantly originated from the skeletal muscles ( 19/20 ) , presenting as lobulated mass with infiltrative growth(20/20);(2) A few claw-shaped neo-arteries(7/7) were delineated in the periphery of the mass in the 3D DCEMRA images as well as the mild tumor staining(7/7);(3) Based on the MRI findings, the parenchyma of 20 AF was divided into two distinct regions of structure: region Ⅰ and region Ⅱ.RegionⅠpresented as hypointensity on both T1-weighted and T2-weighted images and no enhancement after i.v. administration of contrast.Region Ⅱ presented as mild hyperintensity on T2-weighted images and iso-or hypointensity on T1-weighted images and marked enhancement;( 4 ) The signal intensity in T1-weighted images, T2-weighted images and degree of enhancement was 0.10 ±0.02, 0.24 ±0.03, and ( 5.22 ± 0.42)%in regionⅠ, respectively; and 0.79 ±0.04,3.05 ±0.08 and(151.5 ±8.61)% in region Ⅱ, respectively.The differences between regionⅠand regionⅡwere statistically significant of signal intensity in T1-weighted images(t=67.37), and signal intensity in T2-weighted images(t=196.56)and degree of enhancement(t=76.62)(P<0.01);(5) Histologically, AF was composed of fibroblasts, fibrocytes and bundles of collagen fiber.On Masson trichromic stain, regionⅠwas stained blue, being proven the mature collagen fibers.Region Ⅱ was predominantly composed of fibroblasts, fibrocytes and was not stained. Conclusion The region Ⅰ and region Ⅱ are the characteristic MRI manifestations of AF, and MRI precisely reflects the histopathological and biological feature of the tumor.