四肢血管瘤的MRI表现与病理对照及临床意义

目的：探讨四肢软组织血管瘤的MRI表现与病理组织学关系，评价四肢血管瘤MRI表现的临床意义。方法：收集经手术病理证实的四肢软组织血管瘤33例，分析其在MRI上的形态、内部结构及信号特点，并与手术病理结果进行比较。结果：33例四肢血管瘤的MRI形态上可分为三大类型：Ⅰ型：血窦细密型血管瘤，12例，血窦细小、排列紧密，MRI图像不能分辨单个血窦，瘤体内可有或无结缔组织间隔，畸形血管组织可被分割成畸形巢状改变，在T2WI上为高信号，肿块边界清楚，其病理结果5例为毛细血管瘤，3例为肉芽组织型血管瘤，4例为海绵状血管瘤。Ⅱ型：血窦疏松型血管瘤，6例，血窦粗大，排列疏松，血窦间隙较宽，边缘不规则，边界不清，在T2WI上血窦呈均匀高信号，血窦间隙规则，沿血管分布，手术病理结果均为大血管血管瘤。Ⅲ型：弥漫型血管瘤，15例，其中8例血管瘤主要位于骨胳肌内，3例血管瘤局限于骨胳肌内，另4例血管瘤以侵犯皮下脂肪为主。畸形血管在T2WI上呈弥漫线样、斑点状、小斑片状高信号，畸形血管组织之间有大量混杂信号，受累骨胳肌外形可增粗，也可萎缩缩小。手术病理结果：11例为肌内血管瘤，4例为脂肪血管瘤。结论：四肢软组织血管瘤在MRI上具有特征性表现，与其病理组织学类型有较高的对应关系，术前MRI检查对临床治疗有一定的指导意义。

Comparing MRI manifestation of hemangiomas of upper and lower extremities with the related pathology

Objective：Analysis the MRI findings of soft tissue hemanglomas and evaluate its significance of MRI features. Methods： Retrospectively analysis MRI findings of soft tissue hemangiomas proved by operation and pathology （ n = 33 ： M, 19 ; F, 14）. Disclose the correlation between MRI findings and pathology. Results：MRI features of 33 cases could be divided into 3 types：type Ⅰ （n= 12） ： compact type; type Ⅱ （n=6）： loose type; type Ⅲ（n= 15）： diffuse type. Type Ⅰ has clear border, homogeneous high signal in the lesion and low signal interweaved, and the homologous pathologic type include capillary hemangioma （n = 5）, hemangioma of granulation tissue （n = 3） and cavernous hemangioma （n= 4）. Type Ⅱ, because of large blood sinus and broad interval, manifested hyperintensity signal and hypointeusity signal of interval on T2WI, and the homologous pathologic type was big vessel hemangioma; type Ⅲ presented as diffuse patch, mottled, linear, hypersigual leision on T2WI, and the homologous pathologic type was intramuscular hemangioma （n = 11 ） and lipoangioma （n = 4）. Conclusion： Soft tissue hemangiomas have characteristic MIU findings, and it has obvious dependence to the pathology type. Preoperative MRI examination has some extent guidence significance to clinic treatment.