本文關(guān)鍵詞： 神經(jīng)纖維瘤 病理學(xué) 體層攝影術(shù) X線計(jì)算機(jī) 磁共振成像　出處：《中國(guó)臨床醫(yī)學(xué)影像雜志》2017年06期 　論文類型：期刊論文

【摘要】：目的 :探討原發(fā)于顱內(nèi)的孤立性纖維性腫瘤(Intracranial solitary fibrous tumor,ISFT)的影像學(xué)特征及病理學(xué)對(duì)照分析。方法:回顧性分析2005年1月—2015年12月我院收治的8例ISFT患者,所有病灶均經(jīng)術(shù)后病理證實(shí)。行頭CT平掃6例,其中4例行增強(qiáng)檢查,全部8例均行頭MR平掃及增強(qiáng)檢查。結(jié)果:臨床主要癥狀為頭痛(5/8)。所有病例均為單發(fā)病灶,大部分位于幕上(6/8),且與腦膜關(guān)系密切。腫瘤長(zhǎng)徑3~7 cm不等(平均4.5 cm),分葉狀、類圓形或不規(guī)則形。CT示腫瘤以囊實(shí)混雜為主(4/6),不均勻強(qiáng)化者可見迂曲血管影。MR示腫瘤邊界清晰,多數(shù)瘤周無(wú)或輕度水腫(5/8)。T_1WI以等信號(hào)為主,T_2WI信號(hào)混雜,部分病灶(5/8)高低信號(hào)分界清晰。囊實(shí)混雜者明顯不均勻強(qiáng)化,部分病灶(4/8)T_2WI低信號(hào)區(qū)可見強(qiáng)化。病理示瘤細(xì)胞以梭形為主,排列方式多變,細(xì)胞密集區(qū)與疏松區(qū)交替出現(xiàn),間質(zhì)富含血管,可見膠原、黏液樣變。免疫組化示Vimentin彌漫陽(yáng)性(8/8),CD34陽(yáng)性率87.5%(7/8),Bcl-2陽(yáng)性率75%(6/8),Ki-67 5%~20%不等。病理診斷良性4例,低度惡性2例,交界性2例。結(jié)論:ISFT通常為單發(fā)腫塊,邊界清晰,幕上多見,與腦膜關(guān)系密切,多以囊實(shí)混雜為主。T_2WI可特征性表現(xiàn)為"陰陽(yáng)征",增強(qiáng)掃描明顯不均勻強(qiáng)化,T2WI低信號(hào)區(qū)可見強(qiáng)化,僅依靠影像學(xué)診斷準(zhǔn)確率不高,需結(jié)合病理及免疫組化。此外,部分良性病灶可惡變、復(fù)發(fā),故應(yīng)定期隨訪。
[Abstract]:Objective: to investigate the imaging features and pathological features of solitary solitary fibrous tumor (ISFT) in patients with intracranial solitary fibrous tumors. Methods: eight patients with ISFT from January 2005 to December 2015 were retrospectively analyzed. All lesions were confirmed by pathology after operation. Plain CT scan was performed in 6 cases, of which 4 cases were examined with enhanced CT, and 8 cases with head Mr plain scan and enhanced MRI. Results: the main clinical symptom was headache 5 / 8. All cases were single lesions. Most of them were located in 6 / 8 of supratentorial and had close relationship with meninges. The length of tumor varied from 3 to 7 cm (mean 4.5 cm / cm), lobular, round or irregular shape. Ct showed that the tumor was mainly composed of cystic and solid mixtures (4 / 6 / 6), and that in those with uneven enhancement, the boundary of the tumor was clear and tortuous. Most of the tumors had no or mild edema on 5 / 8 / T _ 1WI. The main signal intensity was iso-signal and T _ 2WI. The signal boundary of 5 / 8 / 8 of partial lesions was clear. The thickening of cyst and solid was obviously uneven, and the low signal area of 4 / 8 / 8 T _ 2WI was enhanced in some lesions. The pathological results showed that the tumor cells were mainly fusiform, and the pathological results showed that the tumor cells were mainly fusiform. The pattern of arrangement was variable, the cells concentrated area and loose area appeared alternately, the interstitial substance was rich in blood vessels, collagen and mucus like degeneration could be seen. Immunohistochemical staining showed that Vimentin diffuse positive 8 / 8 / 8% + CD34 positive rate was 87.5%. The positive rate of 75 / 8 / 8% Bcl 2 was 75 / 8% and 20% respectively. Pathological diagnosis was benign in 4 cases, and low grade malignant in 2 cases, the pathological diagnosis was benign in 4 cases and low-grade malignant in 2 cases. ConclusionTwo cases of borderline lesions are usually characterized by simple mass with clear boundary, more supratentorial, and close relationship with meninges. Most of them are characterized by "yin and yang sign" on T _ 2WI. The enhancement of hypointensity on T _ 2WI is obviously inhomogeneous on contrast enhanced scan, and it can be seen in hypointensity area on T _ 2WI. Only relying on imaging diagnosis accuracy is not high, need to be combined with pathology and immunohistochemistry. In addition, some benign lesions abominable, recurrence, so should be followed up regularly.
【作者單位】： 中國(guó)醫(yī)科大學(xué)附屬盛京醫(yī)院放射科;
【基金】：盛京自由研究者基金201402
【分類號(hào)】：R445.2;R739.41

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