纤维脂肪性血管性病变的MRI表现分析

纤维脂肪性血管性病变的MRI表现分析

李海婷1 胡文笳2 樊红光1 董长宪3 龚毓宾3 范盼红4 史大鹏1

本文来源：《中华整形外科杂志》2023年2月第39卷第2期

DOI: 10. 3760 / cma.j.cn114453-20220129-00023

作者单位：1河南省人民医院医学影像科，郑州450003； 2河南省人民医院超声科，郑州450003； 3河南省人民医院血管瘤科，郑州450003； 4河南省人民医院病理科，郑州450003

通信作者：史大鹏，Email：cjr.shidapeng@vip.163.com

引用本文

李海婷, 胡文笳, 樊红光, 等. 纤维脂肪性血管性病变的MRI表现分析 [J] . 中华整形外科杂志, 2023, 39(3) : 261-265. DOI: 10.3760/cma.j.cn114453-20220129-00023.

【摘要】

目的探讨纤维脂肪性血管性病变(FAVA)的MRI特征。

方法回顾性分析2016年1月至2021年6月河南省人民医院临床及病理证实的FAVA患者的临床资料。通过分析FAVA的MRI影像表现，包括病变的部位、形态、信号、强化程度、内部结构、外周结构及其他影像特点，总结其MRI特征。

结果全组共纳入30例患者，男13例，女17例，年龄(18.5±12.8)岁(4~53岁)。病变部位：小腿12例、大腿12例、上臂4例、前臂1例、躯干1例。下肢有24例。所有病例均累及肌层，其中浅肌层21例，深肌层7例，深浅肌层均受累2例，浅肌层受累23例。受累肌肉较多者为股四头肌10例，腓肠肌7例。病变形态：所有病灶均为平行于肌肉长轴生长的肌内实性肿块，其中11例局灶型，11例局部浸润型，8例弥漫型。MRI表现：病灶均呈混杂信号，T1WI有28例在中高信号的背景上见云絮状、条带状、斑片状高信号分布区；脂肪抑制T2WI 30例均在高信号的背景上见树枝状、条带状、云絮状中低信号分布区；增强扫描病变区呈中等至明显不均匀渐进性强化；27例病灶内部见形状不一的脉管影，28例病灶邻近可见引流静脉影，后者中24例位于病灶近心端；26例病灶外周可见筋膜尾征，其中23例位于病灶上下两端。

结论 FAVA的MRI多表现为下肢浅肌层内的平行于肌肉长轴的实性肿块，T1WI中高信号背景上的云絮状、条带状、斑片状高信号，脂肪抑制T2WI高信号背景上的树枝状、条带状、云絮状中低信号，对FAVA的诊断有提示意义，结合筋膜尾征和引流静脉及临床表现等可以在一定程度上明确诊断FAVA，为其临床决策提供参考依据。

【关键词】血管瘤；脉管畸形；纤维脂肪性血管性病变；磁共振成像；诊断

MRI features of fibro-adipose vascular anomaly

Li Haiting1, Hu Wenjia2, Fan Hongguang1, Dong Changxian3, Gong Yubin3, Fan Panhong4, Shi Dapeng1

1Department of Medical Imaging, People’s Hospital of Henan Province, Zhengzhou 450003,China; 2Department of Ultrasound, People’s Hospital of Henan Province, Zhengzhou 450003,China; 3Department of Hemangioma Surgery, People’s Hospital of Henan Province, Zhengzhou 450003,China; 4Department of Pathology, People’s Hospital of Henan Province, Zhengzhou 450003,China

Corresponding author: Shi Dapeng, Email: cjr.shidapeng@vip.163.com

【Abstract】

Objective To explore the clinical symptoms, imaging and histopathological features of fibroadipose vascular anomaly (FAVA), and to propose the differential diagnostic criteria for FAVA and intramuscular venous malformation (IMVM).

Methods Clinical data of FAVA and IMVM patients admitted to the Department of Burn and Plastic Surgery, Jinling Hospital of Nanjing Medical University, General Hospital of Eastern Theater Command from January 2016 to December 2020 were retrospectively analyzed. The patients were divided into FAVA group and IMVM group, and the clinical symptoms, coagulation function and imaging results of the two groups were analyzed. The pathological characteristics of the surgically resected specimens were observed by HE staining, and the similarities and differences between FAVA and IMVM were summarized. Pearson chi-square test was used to investigate the occurrence of local intravascular coagulation (LIC) between the two groups, and P<0.05 was considered statistically significant.

Results Fourteen patients were included in FAVA group, including 4 males and 10 females. The age of treatment was (28.2 ± 13.2) years old and the age of onset was (20.5 ± 10.1) years old. A total of 39 patients were included in the IMVM group, including 16 males and 23 females. The age of treatment was (28.5 ± 14.1) years old and the age of onset was (18.8 ± 9.5) years old. The clinical symptoms of FAVA and IMVM patients were pain, swelling and paresthesia. MRI images of the FAVA group showed fat signal in muscle and varicose vascular shadow. The IMVM group showed large irregular vascular shadows in muscle without fat signal. Histopathological observation revealed fibroadipose hyperplasia accompanied by varicose veins in FAVA group. However, in IMVM group, the lesions showed a large number of malformed veins mixed with muscle, without fibroadipose hyperplasia. There were 2 cases of LIC in FAVA group and 21 cases of LIC in IMVM group, the difference was statistically significant (χ2 =4.39, P=0.036).

Conclusion The clinical symptoms of FAVA and IMVM are similar. The differential diagnosis of FAVA and IMVM requires MRI and pathological examination. The main difference is that there is fibroadipose hyperplasia in FAVA lesion, while there is no fibroadipose hyperplasia in IMVM lesion.

【Key words】Hemangioma；Vascular malformation; Fibro-adipose vascular anomaly; Magnetic resonance imaging; Diagnosis

Disclosure of Conflicts of Interest: The authors have no financial interest to declare in relation to the content of this article.

Ethical Approval: Ethical approval was given by the Medical Ethics Committee of Henan Provincial People’s Hospital.

纤维脂肪性血管性病变(fibro-adipose vascular anomaly, FAVA)是一种由纤维、脂肪、血管构成的复杂血管畸形。由于其病理学表现缺乏特征性，2018年国际脉管疾病研究学会(International Society for the Study of Vascular Anomalies, ISSVA)将其分类为"暂未归类的血管性病变"[1]。目前临床、病理及影像对该病的认识尚不深入，常被误诊为其他类型的血管畸形甚至肿瘤性病变，带来临床诊断及治疗上的困惑。本文回顾性分析河南省人民医院多年来确诊为FAVA的病例，对其MRI表现进一步分析，旨在为临床及影像诊断提供依据。

资料与方法

一、资料选择

回顾性分析2016年1月至2021年6月，河南省人民医院经临床及手术病理证实的FAVA患者的临床资料。诊断标准按照ISSVA血管瘤和脉管畸形分类(2018版)[1]及中华医学会整形外科学分会血管瘤和脉管畸形的诊断及治疗指南(2019版)[2]。纳入标准：(1)结合患者的临床、影像、实验室检查，满足FAVA的病理诊断标准；(2)有完整的MRI影像资料。排除标准：(1)合并其他类型的血管瘤和脉管畸形；(2)有其他器质性疾病。本研究已通过河南省人民医院伦理委员会批准；患者对本研究知情，并同意将其资料用于本研究。

二、检查方法

采用德国Siemens Prisma 3.0 T、TrioTim 3.0 T、Verio 3.0 T MRI扫描仪，依据病变部位采用18通道体线圈或64通道头线圈。扫描参数：层厚4~6 mm,层间距0~0.5 mm，矩阵256×256。平扫包括：横轴位快速自旋回波(spin echo, TSE)T1WI，重复时间(repetition time, TR)1 110、283 ms，回波时间(echo time, TE)12、9 ms；横轴位脂肪抑制TSE序列T2WI，TR 3 000、4 700 ms，TE 81、99 ms；依据病变部位加扫冠状位或矢状位T2WI(参数同横轴位)。增强扫描采用横轴位，依据病变部位加扫冠状位或矢状位脂肪抑制TSE序列T1WI-FS(参数同平扫)。对比剂为二乙三胺五醋钆，剂量0.1 mmol/kg，高压注射器注射，流率2.0 ml/s。

三、影像学分析

由2位具有9年和12年骨肌影像学诊断经验的主治医师分别对图像进行分析，分析内容包括病变的部位、形态、信号、强化程度、内部结构、外周结构及其他影像表现特点，意见不一致时邀请第3位医师(30年骨肌影像学诊断经验的主任医师)参与图像分析，以达成一致。

结果

一、一般资料

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纤维脂肪性血管性病变的MRI表现分析