摘要
目的探讨外周原始神经外胚层肿瘤(PNETs)的CT和MRI表现,提高对本病的认识。方法回顾性分析29例经病理证实的PNETs。男性21例,女性8例,男:女=2.63:1,年龄2个月～69岁,中位年龄为39.00岁。27例为单发病变,2例为多发病变。发病部位:①头颈部9例,位于口底、舌根部及皮下5例,4例位于鼻窦区;②腹部和盆腔9例,其中腹膜后5例、盆腔2例(其中1例位于宫颈)、胃窦部1例、腹股沟区皮下1例;③胸部5例,肺2例,其中1例肺内2个病灶。胸壁3例;④四肢3例,其中髂骨1例,左侧股骨头颈区1例,1例为椎体附件及双侧髂骨多发病变;⑤椎管3例,胸段椎管2例,颈椎硬膜外1例。影像学检查包括CT检查(n=25)和MR检查(n=9)。CT检查当中,平扫17例,增强扫描5例,同时行平扫和增强扫描3例。MR检查中,平扫7例(序列包括FSE T1WI,Fat-Sat FSE T2WI,STIR),增强扫描1例(序列Fat-Sat SE T1WI),同时行MR平扫和增强检查1例。结果①软组织肿块:29例中,27例出现软组织肿块,其中26例单发,1例多发;②病变大小与数目:29例中,27例为单发病灶,2例为多发,病变直径0.7～20.5cm,平均(5.64±4.45)cm;③病变形态:肿瘤均呈不规则形或类圆形,14例边界不清楚,与邻近结构分界不清。15例有明确边界;④病变密度:15例肿瘤呈均匀实性肿块,14例肿块内见囊状低密度区。肿块实性成分CT值平均(34.34±13.27)HU。均无钙化或瘤骨;⑤病变信号:肿瘤呈等长T1不均匀长T2信号影,STIR呈不均匀高信号;⑥增强扫描:CT增强扫描8例及MR增强扫描2例,病变实性成分均表现为不均匀强化,CT示低密度区无强化;⑦邻近骨结构改变:6例见溶骨性骨质破坏,破坏区形态不规则,骨皮质连续性中断,无骨膜反应。结论 PNETs可累及全身任意部位,CT和MRI主要表现为较大的不规则形软组织肿块及溶骨性骨质破坏,无钙化或瘤骨,少见骨膜反应。CT和MR能够准确显示病变大小、形态、结构、与邻近组织的关系、骨结构等变化,具有一定特征性,结合临床表现对本病定量、定性诊断具有重要价值。
Objective To investigate the findings and its diagnostic value of CT and MRI on peripheral primitive neuroectodermal tumors （pPNETs） . Methods There were 29 patients with peripheral PNETs pathologically proved were performed CT and MRI retrospectively. The patients were 21 males and 8 females （M： F= 2. 63： 1）, with median age of 39.00 years （2 month-69 years）. 27 cases with solitary lesion, 2 cases with multiple leions. Sites of lesions involvement were 9 cases in head and neck region （5 in mouth floor, tongue root, subcutaneous and 4 in paranasal sinus）, 9 cases in the abdomen and pelvis （5 in retroperitoneum, 2 in pelvis, 1 in gastric antrum and 1 in inguinal region）, 5 cases in chest （2 in lung, 3 in chest wall）, 3 cases in extremities （1 in ilium, 1 in femoral head and neck and 1 were multiple lesions in vertebral body accessories and bilateral ilium）, and 3 cases in intraspinal （2 in thoracic spinal canal, 1 in cervical epidural）. Results 27 in 29 cases showed soft tissue mass, 26 of 27 cases with solitary and another 1 with multiple lesions. Tumor size ranged from 0.7-20.5 cm average （5.64±4.45） cm. Of the 29 cases, 27 cases with solitary lesion, 2 cases with multiple lesions. The lesions were irregular or roundness, 14 cases with poorly circumscribed and 15 cases with well- circumscribed. 15 cases showed homogeneous density with average CT value （34.34~ 13.27） HU, 14 cases inhomogeneous with cystic low density areas within lesions. No calcification or osteoid tissue were found within the lesions. The tumors were usually intermediate or hypointense signal on TI WI and heterogeneous hyperintense signal on T2WI and STIR. All of the lesions were heterogeneous enhancement on CT and MRI. There were 6 eases demonstrated irregrular os-teolytic lesion and cortical discontinuous in adjacent hone, without periosteal reaction. Conclusion This disease can involve any part of the body. The manifestation of peripheral PNET on CT and MRI have ill-defined soft tissue mass and osteolytic bone destruction, no calcification or osteoid tissue within the lesions, and rare periosteal reaction. CT and MR can manifestate the size and shape of the lesions, the relationship with other tissue and bone structure, it is useful to diagnose the pPNET with CT and MRI features combine with clinical presentation.
出处
《医学影像学杂志》
2013年第3期379-383,共5页
Journal of Medical Imaging
关键词
外周原始神经外胚层肿瘤
骨肿瘤
体层摄影术
X线技术机
磁共振成像
Perippheral primitive neuroectodermal tumors
Bone neoplasms
Computed tomography （CT）
Magneticresonance imaging （MRI）
