Spectrum of Fat-containing Soft-Tissue Masses at MR Imaging: The Common, the Uncommon, the Characteristic, and the Sometimes Confusing
Spectrum of Fat-containing Soft-Tissue Masses at MR Imaging: The Common, the Uncommon, the Characteristic, and the Sometimes Confusing
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DOI：
10.1148/rg.2016150133
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发表时间：
2016-05-01
期刊：
影响因子：
5.5
通讯作者：
Pacholke, David A.
中科院分区：
文献类型：
--
作者：
Gupta, Pushpender;Potti, Tommy A.;Pacholke, David A.
含脂肿瘤是临床上最常见的软组织肿瘤。绝大多数含脂肪的软组织肿块是良性的。脂肪瘤是最常见的良性含脂肪肿块，在磁共振（MR）成像中表现出特征性的外观。较少见的良性软组织肿块包括成脂细胞瘤、血管脂肪瘤、梭形细胞脂肪瘤/多形性脂肪瘤、肌脂肪瘤、软骨样脂肪瘤、神经脂肪增多症、脂肪增多症、冬眠瘤和脂肪坏死。分化良好的脂肪肉瘤（WDLPS）/非典型脂肪瘤（ALT）是局部侵袭性软组织肿块，不会转移。生物学上更具侵袭性的脂肪肉瘤包括粘液样、多形性和去分化脂肪肉瘤。在MR成像中，脂肪瘤典型地类似于皮下脂肪，但可能包含一些薄的间隔。增厚、不规则、强化的分隔和非脂肪性软组织肿块提示脂肪肉瘤而非脂肪瘤。然而，良性脂肪瘤病变和WDLPS/ALT往往有重叠的MRI表现。在影像学上区分WDLPS/ALT与良性脂肪瘤性病变或脂肪坏死具有挑战性，通常需要进行组织学评价。我们使用世界卫生组织的脂肪细胞肿瘤分类，重点介绍了常见的病变、与特定肿瘤相关的特征性MR成像结果以及可能需要组织学采样的某些肿瘤的重叠MR成像结果。我们还简要讨论了分子标记物在含脂肪软组织肿块的正确表征和分类中的作用。(C)RSNA，2016
Fat-containing tumors are the most common soft-tissue tumors encountered clinically. The vast majority of fat-containing soft-tissue masses are benign. Lipomas are the most common benign fat-containing masses and demonstrate a characteristic appearance at magnetic resonance (MR) imaging. Less common benign soft-tissue masses include lipoblastoma, angiolipoma, spindle cell lipoma/pleomorphic lipoma, myolipoma, chondroid lipoma, lipomatosis of nerve, lipomatosis, hibernoma, and fat necrosis. Well-differentiated liposarcomas (WDLPSs)/atypical lipomatous tumors (ALTs) are locally aggressive soft-tissue masses that do not metastasize. Biologically more aggressive liposarcomas include myxoid, pleomorphic, and dedifferentiated liposarcomas. At MR imaging, lipomas typically resemble subcutaneous fat but may contain a few thin septa. The presence of thick, irregular, enhancing septa and nonfatty soft-tissue mass components suggests liposarcoma rather than lipoma. However, benign lipomatous lesions and WDLPS/ALT often have overlapping MR imaging findings. Distinguishing WDLPS/ALT from a benign lipomatous lesion or from fat necrosis at imaging can be challenging and often requires histologic evaluation. We present the spectrum of fat-containing masses, using the World Health Organization classification of adipocytic tumors, with an emphasis on commonly encountered lesions, characteristic MR imaging findings associated with specific tumors, and overlapping MR imaging findings of certain tumors that may require histologic sampling. We also briefly discuss the role of molecular markers in proper characterization and classification of fat-containing soft-tissue masses. (C) RSNA, 2016