MRI、CT和病理检查对肢体脂肪肉瘤诊断价值的比较朱刚;孙海斌;汪浒;徐刚【摘要】Objective:To compare the detection results of histopathology and MRI, CT of liposarcoma of extremities,and to provide guide for increasing the accuracy rate of clinical diagnosis.Methods:The data of 43 cases of liposarcoma of the extremities were collected.MRI plain scan and enhanced CT were used in 18 patients before operation.Sixteen cases were diagnosed by CT plain scan and enhanced scan before operation.Nine cases were diagnosed by MRI and CT plain scan and enhanced scan before operation.All the patients underwent the operation. The intraoperative pathological examination was performed in the lesion tissue.The diagnosed results were assessed according to the classification (high differentiated liposarcoma, mucoid liposarcoma, toliposarcoma and mixed liposarcoma).Results:In all the 43 cases,the upper limb lesion was found in 13 patients and the lower limb lesion was found in 30 patients.The average maximal diameter of the lesions was (14.6±6.1)cm.The fat cells w ere found in all the patients,with the pathological characteristics of adipocytes and lipopolysaccharide mixture exists, and accompanied by deep-stained pleomorphic cells;the CT examination results showed that the low density shadow with clear boundary and linear separated shadow after CT enhanced;the MRI image showed short signal intensity on T1 weighted imaging and long signal intensity on T2 long signal and short time reversal recovery sequence imaging and other signals;the mass existed the cord-like,linear shadow;the lesion surrounding nerve and blood vessels were squeezed,but the bone structure was relatively complete.The CT and MRI results of well-differentiated lipsarcome showed the fat signal,and the enhanced results showed the mild strengthening.The CT and MRI results of mucinous liposarcoma showed the cystic density and signal, and the enhanced results showed the clound-like orlatticed mild and moderate strengthening;the CT and MRI results of mixed liposarcoma showed the mixed imaging findings of above two types.Conclusion:The pathological examination can provide the exact basis for the diagnosis of type of liposarcoma;CT and MRI imagings can provide basis for j udging the size of the tumor;MRI enhanced scan has an important role in judging tumor bination of three kinds of detection methods can provide the basis for the diagnosis of the disease.%目的:分析四肢肢体脂肪肉瘤的MRI和CT检测结果,并与病理检查结果进行对照,以提高术前诊断的准确率.方法:收集43例四肢脂肪肉瘤患者的临床资料,18例患者于手术治疗前行MRI平扫及增强扫描辅助诊断,16例患者于手术治疗前行CT平扫及增强扫描辅助诊断,另外9例患者术前行MRI及CT平扫及增强扫描辅助诊断,所有患者均行手术切除肿瘤,术中取病变组织行病理检查.将其按照分型方式(分别为高分化型脂肪肉瘤、黏液型脂肪肉瘤、去分化型脂肪肉瘤及混合型脂肪肉瘤)评定其诊断结果.结果:43例患者中,发病部位在上肢者13例,在下肢者30例,病灶平均直径为(14.6±6.1)cm.所有患者病变组织均可见不同大小的脂肪细胞,病理学特征为脂肪细胞与脂母细胞混合存在,伴有可被深染的多形性细胞;CT检查,基本特征为病灶呈不规则低密度阴影但边界清晰,增强后显示病变部位分隔明显增强;MRI检查,基本特征为T1短信号、T2长信号及短时间反转恢复序列成像等信号,肿块内存在条索状和线状阴影,病变组织周围神经与血管呈被挤压样,但骨质结构相对完整.分化良好型脂肪肉瘤CT和MRI以脂肪信号为主,增强后轻度强化;黏液型脂肪肉瘤CT和MRI表现为囊性密度及信号,增强后可见云絮状、网格状轻中度强化;混合型脂肪肉瘤具有上述2种类型混合的影像学表现.结论:病理检查可为确诊脂肪肉瘤的类型提供确切依据,CT和MRI影像学检查可为判断肿瘤大小提供依据,MRI造影增强后扫描对明确肿瘤边界有重要作用,3种检查方法联合使用可为确诊该病提供依据.【期刊名称】《吉林大学学报（医学版）》【年(卷),期】2017(043)006【总页数】6页(P1215-1219,封2)【关键词】脂肪肉瘤;病理检查;磁共振成像;电子计算机断层扫描【作者】朱刚;孙海斌;汪浒;徐刚【作者单位】郑州大学第五附属医院骨外科,河南郑州 450052;郑州大学第五附属医院病理科,河南郑州 450052;郑州大学第五附属医院放射影像科,河南郑州450052;河北医科大学第二医院烧伤整形科,河北石家庄 053600【正文语种】中文【中图分类】R738.6在成人的软组织肉瘤中，脂肪肉瘤的发病率居第2位，占恶性软组织肿瘤的10%～35%[1]，是原发性软组织恶性肿瘤最常见的类型。
