CAJ | 학술논문

目的探讨良恶性孤立性纤维性肿瘤（SFT）的影像学特征，提高其影像诊断水平。资料与方法回顾性分析经手术病理证实的24例 SFT 的术前 CT 及 MRI资料，观察肿瘤部位、大小、形态、密度（信号）、增强类型及与周围组织的关系，其中 MRI 平扫7例，增强扫描5例；CT 平扫17例，增强扫描11例；并与病理结果进行对照。结果23例瘤体呈实性，1例呈囊实性。影像诊断20例良性，2例恶性，2例良性误诊为恶性，影像诊断符合率为91.7%（22/24）。5例良性肿瘤（最大直径<4 cm）密度均匀，7例（最大直径>5 cm）密度不均，4例钙化，7例出现坏死，呈类圆形或不规则形。CT 增强扫描后进行性增强型5例，速升缓降型5例，轻度强化型1例。MRI 平扫肿瘤实质部分4例 T1WI 呈等信号，T2WI 呈等、稍高信号；3例 T1WI 呈等、低信号，T2WI 呈等、低或稍高混杂信号，DWI 呈稍高信号，增强扫描后实质部分均明显强化；2例恶性肿瘤密度不均，边界不清，均有周围浸润性改变，增强扫描呈进行性强化。病理提示肿瘤主要由梭形细胞构成，并富含纤维及血管。结论良恶性 SFT 的影像学表现有一定的特征，出现侵袭性生长为恶性SFT 影像诊断的可靠征象。MRI 出现 T1WI 或 T2WI 呈等、低信号的实质部分明显强化征象有助于 SFT 的诊断，最终确诊依靠病理检查。
목적탐토량악성고립성섬유성종류（SFT）적영상학특정，제고기영상진단수평。자료여방법회고성분석경수술병리증실적24례 SFT 적술전 CT 급 MRI자료，관찰종류부위、대소、형태、밀도（신호）、증강류형급여주위조직적관계，기중 MRI 평소7례，증강소묘5례；CT 평소17례，증강소묘11례；병여병리결과진행대조。결과23례류체정실성，1례정낭실성。영상진단20례량성，2례악성，2례량성오진위악성，영상진단부합솔위91.7%（22/24）。5례량성종류（최대직경<4 cm）밀도균균，7례（최대직경>5 cm）밀도불균，4례개화，7례출현배사，정류원형혹불규칙형。CT 증강소묘후진행성증강형5례，속승완강형5례，경도강화형1례。MRI 평소종류실질부분4례 T1WI 정등신호，T2WI 정등、초고신호；3례 T1WI 정등、저신호，T2WI 정등、저혹초고혼잡신호，DWI 정초고신호，증강소묘후실질부분균명현강화；2례악성종류밀도불균，변계불청，균유주위침윤성개변，증강소묘정진행성강화。병리제시종류주요유사형세포구성，병부함섬유급혈관。결론량악성 SFT 적영상학표현유일정적특정，출현침습성생장위악성SFT 영상진단적가고정상。MRI 출현 T1WI 혹 T2WI 정등、저신호적실질부분명현강화정상유조우 SFT 적진단，최종학진의고병리검사。
Purpose To analyze the imaging manifestations of solitary fibrous tumors (SFT) so as to improve its diagnosis. Materials and Methods The CT and MRI findings of 24 patients with SFT confirmed pathologically were analyzed retrospectively and compared respectively with their pathological results in terms of lesion's location, size, shape, density (signal), type of enhancement and relationship with the surrounding tissues. Seven patients underwent MRI scan, 5 were with enhanced scan; 17 patients were carried out plain CT scan and 11 were with enhanced CT scan. Results The lesions in the 23 cases were solid and 1 was solid and cystic. Through the imaging diagnosis, 20 cases were diagnosed as benign tumors, 2 cases were diagnosed as malignancies, and 2 benign tumors were misdiagnosed, which showed that the diagnose accordance rate was 91.7%(22/24). On plain CT scans, 5 lesions (maximum diameter<4 cm) showed homogeneous density; 7 cases (maximum diameter>5 cm) showed heterogeneous density, 4 of which had calcification and 7 had necrosis; the shapes were round-like or lobulated. On enhanced CT scans, 5 cases presented progressive enhancement pattern, 5 cases showed fast-in and slow-out pattern, 1 case showed slight enhancement pattern. On MRI scan, 4 cases of the solid part of tumors showed isointensity signals on T1WI and isointensity or slight hyperintensity signals on T2WI, 3 cases showed isointensity or low signals on T1WI and low, isointensity or slight hyperintensity signals on T2WI, and slight hyperintensity signal on DWI, the solid part of tumors were strongly enhanced. Two malignant tumors presented features like heterogeneous density, unclear boundary, invasive growth and progressive enhancement pattern. The pathological findings demonstrated that the tumor tissues mainly consisted of spindle cells with rich fibers and vessels. Conclusion The imaging findings of benign and malignant SFT have certain features, malignant SFT have invasive growth signs. The obvious progressive enhancement of solid component which shows isointensity and hyperintensity on T1WI or T2WI may be helpful in the diagnosis of SFT; however, the final diagnosis should be confirmed with histopathology.