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目的分析颈肩部促结缔组织增生性成纤维细胞瘤及侵袭性纤维瘤病的MR、CT特征,重点讨论MRI表现的病理基础。方法分析手术病理证实有MR或CT影像资料的颈肩部促结缔组织增生性成纤维细胞瘤4例及侵袭性纤维瘤病3例的影像表现,并与病理对照。结果(1)4例促结缔组织增生性成纤维细胞瘤均位于颈部肌间隙中,类圆形,边界大部分清晰,1例在MRI上见包膜样改变。CT平扫为均匀低密度(2例)及等低密度夹杂改变(1例),增强后肿块强化不明显,密度改变与平扫时一致。肿瘤在T1WI上为均匀等信号(1例)或等低信号混杂改变(1例);T2WI上2例信号相似于邻近的肌肉,不均匀伴有结节样的低信号或略高信号;增强扫描,病灶强化不明显,仍以等肌肉信号为主,伴有灶性低或略高信号。(2)3例侵袭性纤维瘤病均起源于肌肉本身,长梭形生长,长径与所侵犯的肌肉走向一致,边缘均不规则。CT平扫为等肌肉密度、边界不清晰的肿块(2例);MRT1WI为均匀等信号的占位,边界不清晰(3例);T2WI见夹杂条状或结节状低信号的稍高信号(2例)或均匀高信号(1例);增强扫描肿块均明显强化,条状或结节状的低信号影及不规则的边界显示更加清晰,2例见边缘爪样浸润改变。结论好发于不同年龄的促结缔组织增生性成纤维细胞瘤和侵袭性纤维瘤病都为纤维来源的软组织肿瘤,但影像改变完全不同,这与其不同的病理基础密切相关。MRI的诊断及鉴别诊断作用明显优于CT。
Objective To analyze the features of MR and CT in the promotion of connective tissue proliferative fibromatocytoma and invasive fibromatosis in the neck and shoulder, and to discuss the pathological basis of MRI. Methods The imaging findings of 4 cases of connective tissue proliferating fibroblastoma on the neck and shoulder and 3 cases of invasive fibromatosis confirmed by MR imaging or MR imaging were analyzed and compared with the pathology. Results (1) 4 cases of connective tissue proliferative fibroblastoma were located in the neck muscle space, round, most of the border clear, 1 case of MRI seen in the capsule-like changes. CT scan for uniform low density (2 cases) and other low-density inclusions change (1 case), enhanced enhancement was not obvious, the density changes consistent with the plain scan. Tumors were uniform on T1WI (1 case) or mixed low-signal changes (1 case); 2 cases on T2WI had similar signals to adjacent muscles and were non-uniformly associated with nodular low signal or slightly high signal; Scanning, lesion enhancement is not obvious, and other muscle signals are still the main, with low or slightly higher signal focus. (2) The three cases of invasive fibromatosis all originated from the muscle itself. The long fusiform growth and long diameter coincided with the invading muscles, and the edges were irregular. CT scan for equal muscle density, the boundary is not clear mass (2 cases); MRT1WI for uniform signal occupancy, the border is not clear (3 cases); T2WI see the inclusion of strip or nodular low signal slightly higher signal (2 cases) or even high signal (1 case). The contrast-enhanced scan showed significant enhancement. The stripe or nodular low signal and irregular boundary showed clearer, and the marginal paw-like infiltration changed in 2 cases. CONCLUSIONS: Both connective tissue proliferating fibroblastomas and invasive fibromatosis, which occur in different ages, are fibrous tissue-derived soft tissue tumors. However, the imaging changes are completely different, which is closely related to their different pathological basis. The diagnostic and differential diagnosis of MRI is better than CT.