Khanna Maneesh, Ramanathan Subramaniyan, Kambal Aalaa Salaheldin, Al-Berawi Mohammed, Yadav Santosh, Kumar Devendra, Schieda Nicola
Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar.
Department of Translational Medicine, Sidra Medical and Research Center, Doha, Qatar.
Eur J Radiol. 2017 Jul;92:103-110. doi: 10.1016/j.ejrad.2017.04.010. Epub 2017 Apr 17.
Desmoid tumors are benign myofibroblastic neoplasms, originating from the muscle aponeurosis and classified as deep fibromatoses. The aim of this study was to evaluate the utility of multi-parametric (mp)-MRI for the diagnosis of abdominal wall desmoid tumor (awdt).
This Institutional review board approved retrospective study compared 10 patients (mean age±SD; 38.2±13years; 9 females and 1 male) with awdt to 14 subjects (mean age±SD; 45.6±14.7years; 9 females and 5 males) with non-desmoid abdominal wall tumors (ndawt). All included subjects underwent mp-MRI, which included conventional, diffusion weighted and dynamic contrast-enhanced (DCE) MRI. Two blinded experienced fellowship trained radiologists (MK and SR) evaluated each lesion characteristics qualitatively and quantitatively which included margin, homogeneity, T2W/T1W signal intensity (SI), T2 dark strands, and fascial tail together with measurements of apparent diffusion coefficient (ADC) and semi-quantitative DCE analysis. Inter-observer agreement was assessed using Cohen's kappa and data were compared between groups using independent sample t-tests and Chi-square tests.
No significant differences in age or gender appeared between groups. On qualitative analysis, T2 dark strands were identified in 90% by both radiologist (K=0.82) of awdt, while fascial tail was identified in 70% by radiologist 1 and 80% by second radiologist (k=0.91) of awdt; however no other lesions showed these findings. Other subjective imaging findings did not significantly differ between groups with moderate-to-strong agreements (k=0.7-1.0). On quantitative measurements, diffusion imaging awdt lesions showed higher mean ADC value compared to other lesions, although it did not reached at the level of significance. While on DCE MRI, all awdt lesions showed type 1 (progressive) DCE curve, however no significant difference was observed between groups.
T2 dark strands and fascial tail are characteristic features of awdt, whereas other subjective/qualitative findings are not useful. Quantitative findings such as ADC measurements and DCE curve analysis may have additional value to differentiate awdt from ndawt, but will require further analysis.
硬纤维瘤是一种良性肌成纤维细胞瘤，起源于肌腱膜，归类为深部纤维瘤病。本研究的目的是评估多参数（mp）-MRI对腹壁硬纤维瘤（awdt）的诊断价值。
本机构审查委员会批准的回顾性研究将10例腹壁硬纤维瘤患者（平均年龄±标准差；38.2±13岁；9名女性和1名男性）与14例非硬纤维瘤性腹壁肿瘤（ndawt）患者（平均年龄±标准差；45.6±14.7岁；9名女性和5名男性）进行了比较。所有纳入的受试者均接受了mp-MRI检查，包括常规、扩散加权和动态对比增强（DCE）MRI。两位经验丰富的经过专科培训的放射科医生（MK和SR）对每个病变的特征进行了定性和定量评估，包括边缘、均匀性、T2加权/T1加权信号强度（SI）、T2暗条和筋膜尾，同时测量了表观扩散系数（ADC）和半定量DCE分析。观察者间的一致性采用Cohen's kappa进行评估，组间数据采用独立样本t检验和卡方检验进行比较。
两组在年龄或性别上无显著差异。在定性分析中，两位放射科医生对90%的腹壁硬纤维瘤患者均发现了T2暗条（K=0.82），而第一位放射科医生对70%的患者发现了筋膜尾，第二位放射科医生对80%的患者发现了筋膜尾（k=0.91）；然而，其他病变未出现这些表现。其他主观影像学表现两组间无显著差异，一致性为中度至高度（k=0.7-1.0）。在定量测量中，扩散成像显示腹壁硬纤维瘤病变的平均ADC值高于其他病变，尽管未达到显著水平。而在DCE MRI中，所有腹壁硬纤维瘤病变均显示1型（渐进性）DCE曲线，但组间未观察到显著差异。
T2暗条和筋膜尾是腹壁硬纤维瘤的特征性表现，而其他主观/定性表现并无诊断价值。ADC测量和DCE曲线分析等定量结果可能对区分腹壁硬纤维瘤和非硬纤维瘤性腹壁肿瘤具有额外价值，但需要进一步分析。
