CAJ | 학술논문

目的总结鼻咽癌放疗后继发肉瘤的CT和MRI影像特征.方法回顾性分析鼻咽癌放疗后确诊为继发肉瘤73例患者的临床特征、CT及MRI表现.73例患者中,43例行CT检查,24例行MR检查,6例同时行CT和MR检查.结果继发肉瘤中前3位的病理类型依次为纤维肉瘤45.3％ (33/73)、骨肉瘤31.5％ (23/73)和恶性纤维组织细胞瘤9.6％(7/73).好发部位前3位依次为上颌窦26.7％ (20/73)、颈部软组织17.8％(13/73)及下颌骨13.7％(10/73).鼻咽癌放疗继发肉瘤在CT和MRI上均以形成密度或信号不均匀软组织肿块为主要表现.肿块形态不规则,与周围组织分界不清78.1％(57/73);肿块呈类圆形或圆形,与周围组织分界清楚21.9％(16/73).CT平扫呈等或混杂密度,平扫T2 WI呈稍高信号,T1WI呈等信号.增强扫描明显均匀或不均匀强化65.8％(48/73),中度均匀或不均匀强化23.2％(17/73),轻度均匀或不均匀强化11.0％(8/73).骨肉瘤中,78.3％(18/23)可见新生瘤骨.结论鼻咽癌放疗继发肉瘤的影像表现有一定特征,结合放疗病史及发病部位,借助于放疗后严格、系统的影像复查能够及早做出正确的诊断.
목적 총결비인암방료후계발육류적CT화MRI영상특정.방법 회고성분석비인암방료후학진위계발육류73례환자적림상특정、CT급MRI표현.73례환자중,43례행CT검사,24례행MR검사,6례동시행CT화MR검사.결과 계발육류중전3위적병리류형의차위섬유육류45.3％ (33/73)、골육류31.5％ (23/73)화악성섬유조직세포류9.6％(7/73).호발부위전3위의차위상합두26.7％ (20/73)、경부연조직17.8％(13/73)급하합골13.7％(10/73).비인암방료계발육류재CT화MRI상균이형성밀도혹신호불균균연조직종괴위주요표현.종괴형태불규칙,여주위조직분계불청78.1％(57/73);종괴정류원형혹원형,여주위조직분계청초21.9％(16/73).CT평소정등혹혼잡밀도,평소T2 WI정초고신호,T1WI정등신호.증강소묘명현균균혹불균균강화65.8％(48/73),중도균균혹불균균강화23.2％(17/73),경도균균혹불균균강화11.0％(8/73).골육류중,78.3％(18/23)가견신생류골.결론 비인암방료계발육류적영상표현유일정특정,결합방료병사급발병부위,차조우방료후엄격、계통적영상복사능구급조주출정학적진단.
Objective To summarize the CT and MRI features of radiation-induced sarcoma (RIS) after radiotherapy in patients with nasopharyngeal carcinoma (NPC).Methods From January 1997 to October 2012,a total of 73 NPC patients with RIS after radiotherapy were confirmed by pathology.The clinical data and imaging findings (CT and MRI findings) were retrospectively reviewed.Of the 73 patients,43 underwent CT examination,24 underwent MRI,and the remaining 6 underwent both CT and MRI scans.Results Fibrosarcoma [45.3％ (33/73)] was the most frequently histologic type,followed by osteosarcoma[31.5％ (23/73)] and malignant fibrous histiocytoma [9.6％ (7/73)].The top three common sites were maxillary sinus [26.7％ (20/73)],followed by the neck soft tissue [17.8％ (13/73)] and mandible[13.7％ (10/73)].The main characteristics of the RIS on CT and MRI were soft tissue masses[78.1％ (57/73)] with an irregular shape and ill-defined margin,or rounded masses with welldefined margin [21.9％ (16/73)].CT of 49 patients showed masses with isodensity or mixed density on precontrast CT.MRI of 30 patients showed lesions with isointensity signal on T1WI and intermediate signal intensity on T2WI.On post-contrast images,65.8％ (48/73) tumors showed markedly homogeneous or inhomogeneous enhancement,23.2％ (17/73) lesions showed moderate enhancement,and 11.0％ (8/73) masses showed mild enhancement.Among the 23 patients with radiation-induced osteosarcomas,78.3％ (18/23) presented tumor bone formation.Conclusions RIS has a characteristic imaging features.Clinical history,tumor sites and serial imaging follow-up are necessary for early detection of RIS in patients with NPC.