Wetzel L H, Levine E
Department of Diagnostic Radiology, University of Kansas Medical Center, Kansas City 66103.
AJR Am J Roentgenol. 1990 Nov;155(5):1025-30. doi: 10.2214/ajr.155.5.2120930.
We reviewed MR imaging findings in 14 patients with primary soft-tissue tumors of the foot and compared them with surgical and pathologic findings to determine the value of MR imaging in anatomic localization, delineation, and characterization of such lesions. Nine tumors (64%) were benign, and five (36%) were malignant. The anatomic location (compartment, space, relation to specific tendon) and extent of all tumors were accurately shown by MR imaging. Twelve tumors (86%) were correctly characterized as benign or malignant. Eight (89%) of nine benign lesions showed distinctive MR imaging features that correctly suggested a specific diagnosis. These included hemangioma (high T2-weighted intensity and internal septa), ganglion cyst (homogeneous, high T2-weighted weighted intensity and peritendinous location), plantar fibromatosis (nodularity of plantar aponeurosis with low intensity on all sequences), and pigmented villonodular synovitis (low T2-weighted intensity and lower intensity rim). Aggressive fibromatosis (one case) could not be characterized. Four (80%) of five malignant neoplasms had MR imaging findings suggesting soft-tissue sarcoma. Two synovial sarcomas were inhomogeneous and showed extensive peritendinous growth. Two clear cell sarcomas arose at the origin of the plantar aponeurosis and infiltrated adjacent muscle. A small clear cell sarcoma could not be characterized as benign or malignant. MR imaging of the foot is accurate in showing the extent of soft-tissue tumors, which is helpful for surgical planning. Determination of their specific anatomic location may help characterize some tumors. Although our series is small, it appears that MR imaging often suggests a specific diagnosis in certain benign soft-tissue tumors of the foot and may often correctly distinguish benign from malignant tumors.
我们回顾了14例足部原发性软组织肿瘤患者的磁共振成像（MR）表现，并将其与手术及病理结果进行比较，以确定MR成像在这类病变的解剖定位、边界描绘及特征判断方面的价值。9例肿瘤（64%）为良性，5例（36%）为恶性。MR成像能准确显示所有肿瘤的解剖位置（肌间隔、间隙、与特定肌腱的关系）及范围。12例肿瘤（86%）被正确判定为良性或恶性。9例良性病变中的8例（89%）表现出独特的MR成像特征，可正确提示特定诊断。这些特征包括血管瘤（T2加权像高信号及内部间隔）、腱鞘囊肿（均匀、T2加权像高信号及肌腱周围位置）、足底纤维瘤病（足底腱膜结节状，所有序列均为低信号）及色素沉着绒毛结节性滑膜炎（T2加权像低信号及低信号边缘）。侵袭性纤维瘤病（1例）无法明确特征。5例恶性肿瘤中的4例（80%）具有提示软组织肉瘤的MR成像表现。2例滑膜肉瘤不均匀，显示广泛的肌腱周围生长。2例透明细胞肉瘤起源于足底腱膜并浸润相邻肌肉。1例小的透明细胞肉瘤无法判定为良性或恶性。足部的MR成像能准确显示软组织肿瘤的范围，有助于手术规划。确定其具体解剖位置可能有助于某些肿瘤的特征判断。尽管我们的病例系列较小，但似乎MR成像常能对某些足部良性软组织肿瘤提示特定诊断，且常能正确区分良性与恶性肿瘤。
