Zhang Tianwen, Liu Bin
Department of Orthopaedic Soft Tissue Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People's Republic of China.
Cancer Manag Res. 2024 May 17;16:455-463. doi: 10.2147/CMAR.S457504. eCollection 2024.
The study aimed to investigate the significantly different imaging characteristics of musculoskeletal dedifferentiated liposarcoma (DDLP) and well differentiated liposarcoma (WDLP) on MRI, which in turn could guide puncture biopsy.
This study included 14 patients with DDLP and 16 patients with WDLP, all of whom were confirmed by histopathological examination. The MRI manifestations of these two pathologies were retrospectively reviewed and compared. Furthermore, a step-by-step procedure regarding preoperative puncture biopsy of fatty masses that are suspicious for WD/DD was designed.
Fatty signals can be found in almost all WDs, with a greater proportion of non-fatty areas in DD compared to WD, and it is reasonable to consider WD more likely when the non-fatty areas of the tumor are <25% (p < 0.05), while it is reasonable to consider DD more likely when the non-fatty areas of the tumor are >50% (p < 0.05), and the MRI signals in DD are more complex, inhomogeneous (p < 0.01), usually showed significant enhancement (p < 0.01), and the margins of the tumor were usually indistinct (p < 0.01); and imaging features such as tumor size, vascularity, necrosis, and peritumoral edema did not serve as distinguishing features between the two (p > 0.05).
DD has a greater proportion of non-fatty components, with more complex and inhomogeneous MRI signals, and typically shows significant enhancement, with usually indistinct margins of the tumor, in which the inhomogeneous manifestations are associated with the histological components. The possibility of DD should be considered in fatty tumors with non-fatty areas > 25%, for which puncture biopsy is necessary, while simultaneous puncture of low, moderate, high-signal areas within the non-fatty area could improve the accuracy of preoperative puncture pathology.
本研究旨在探讨肌肉骨骼去分化脂肪肉瘤（DDLP）和高分化脂肪肉瘤（WDLP）在磁共振成像（MRI）上的显著不同影像学特征，进而指导穿刺活检。
本研究纳入14例DDLP患者和16例WDLP患者，所有患者均经组织病理学检查确诊。回顾性分析并比较这两种病变的MRI表现。此外，设计了针对疑似WD/DD的脂肪性肿块术前穿刺活检的分步流程。
几乎所有WDLP中均可发现脂肪信号，与WDLP相比，DDLP中非脂肪区域的比例更高，当肿瘤的非脂肪区域<25%时，考虑WDLP的可能性较大（p<0.05），而当肿瘤的非脂肪区域>50%时，考虑DDLP的可能性较大（p<0.05），DDLP中的MRI信号更复杂、不均匀（p<0.01），通常表现为明显强化（p<0.01），且肿瘤边缘通常不清晰（p<0.01）；而肿瘤大小、血管分布、坏死及瘤周水肿等影像学特征在两者之间并无鉴别意义（p>0.05）。
DDLP中非脂肪成分比例更高，MRI信号更复杂、不均匀，通常表现为明显强化，肿瘤边缘通常不清晰，其中不均匀表现与组织学成分有关。对于非脂肪区域>25%的脂肪性肿瘤，应考虑DDLP的可能性，对此类肿瘤进行穿刺活检很有必要，同时在非脂肪区域内对低、中、高信号区域同时穿刺可提高术前穿刺病理的准确性。
