Volume 42 Issue 6
Dec.  2018
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99Tcm-MIBI SPECT/CT imaging on angiolipoma of the mediastinum: a case report

  • The author reported one case of mediastinal angiolipoma of 99Tcm-MIBI SPECT/CT imaging, The characteristics of the disease were introduced according to clinical symptoms, CT, 99Tcm-MIBI SPECT/CT tumor positive imaging and pathological diagnosis, meanwhile, the understanding of mediastinal angiolipoma was deepened by reviewing the literature. The result of imaging findings of 99Tcm-MIBI SPECT/CT showed no significant ingestion. Conclusion suggests that preoperative multiple imaging examinations are helpful to observe the growth pattern and internal components of mediastinal angiolipoma and is helpful for diagnosis and differential diagnosis.
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  • [1] Howard WR, Helwig EB. Angiolipoma[J]. Arch Dermatol, 1960, 82:924-931. DOI:10.1001/archderm.1960.01580060078011.
    [2] Lin JJ, Lin F. Two entities in angiolipoma. A study of 459 cases of lipoma with review of literature on infiltrating angiolipoma[J]. Cancer, 1974, 34(3):720-727. DOI:10.1002/1097-0142(197409)34:33.0.CO;2-K.
    [3] Wu Z, Wan H, Shi M, et al. Bronchoscopic resection of bronchial angiolipoma:A rare case report[J]. Mol Clin Oncol, 2016, 5(6):850-852. DOI:10.3892/mco.2016.1069.
    [4] Kitagawa Y, Miyamoto M, Konno S, et al. Subcutaneous angiolipoma:magnetic resonance imaging features with histological correlation[J]. J Nippon Med Sch, 2014, 81(5):313-319. DOI:10.1272/jnms.81.313.
    [5] 陈伟君, 孙达. 99Tcm-MIBI显像在乳腺癌新辅助化疗中的应用价值[J].国际放射医学核医学杂志, 2015, 39(6):487-492. DOI:10.3760/cma.j.issn.1673-4114. 2015. 06.011.Chen WJ, Sun D. Clinical value of 99Tcm-MIBI imaging in neoadjuvant chemotherapy of breast cancer[J]. Int J Radiat Med Nucl Med, 2015, 39(6):487-492. DOI:10.3760/cma.j.issn.1673-4114. 2015.06.011.
    [6] 刘洪伟, 李宁毅. 99Tcm-MIBI显像对腮腺区肿块的诊断价值[J].中华核医学杂志, 2011, 31(5):310-312. DOI:10.3760/cma.j.issn.0253-9780.2011.05.008.Liu HW, Li NY. 99Tcm-MIBI SPECT for the differential diagnosis of parotid tumors[J]. Chin J Nucl Med Mol Imaging, 2011, 31(5):310-312. DOI:10.3760/cma.j.issn.0253-9780.2011.05.008.
    [7] Mayooran N, Tarazi M, O'Brien O, et al. Infiltrating angiolipoma of the chest wall:a rare clinical entity[J]. J Surg Case Rep, 2016(1):rjv165. DOI:10.1093/jscr/rjv165.
    [8] 陈超坤, 刘亮, 傅飞先, 等.囊性胸腺瘤和囊性畸胎瘤的影像学特征及鉴别诊断[J].国际放射医学核医学杂志, 2016, 40(1):31-34. DOI:10.3760/cma.j.issn.1673-4114.2016.01.007.Chen CK, Liu L, Fu FX, et al. Imaging features and differential diagnosis of cystic thymoma and cystic teratoma[J]. Int J Radiat Med Nucl Med, 2016, 40(1):31-34. DOI:10.3760/cma.j.issn.1673-4114.2016.01.007.
    [9] 罗红兵, 周鹏, 任静, 等.良恶性胸腺瘤CT表现及诊断价值[J].实用放射学杂志, 2014, 30(9):1462-1465. DOI:10.3969/j.issn.1002-1671.2014.09.010.Luo HB, Zhou P, Ren J, et al. The CT features and diagnostic value for benign and malignant thymoma[J]. J Pract Radiol, 2014, 30(9):1462-1465. DOI:10.3969/j.issn.1002-1671.2014.09.010.
    [10] 陈文, 吴健.纵隔畸胎瘤的CT诊断[J].实用放射学杂志, 2006, 22(6):675-678. doi: 10.3969/j.issn.1002-1671.2006.06.011Chen W, Wu J. CT Diagnosis of Mediastinal Teratoma[J]. J Pract Radiol, 2006, 22(6):675-678. doi: 10.3969/j.issn.1002-1671.2006.06.011
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99Tcm-MIBI SPECT/CT imaging on angiolipoma of the mediastinum: a case report

    Corresponding author: Jianming Ni, jianming_ni@163.com
  • Department of Nuclear Medicine, Wuxi No.2 People's Hospital, Wuxi 214002, China

Abstract: The author reported one case of mediastinal angiolipoma of 99Tcm-MIBI SPECT/CT imaging, The characteristics of the disease were introduced according to clinical symptoms, CT, 99Tcm-MIBI SPECT/CT tumor positive imaging and pathological diagnosis, meanwhile, the understanding of mediastinal angiolipoma was deepened by reviewing the literature. The result of imaging findings of 99Tcm-MIBI SPECT/CT showed no significant ingestion. Conclusion suggests that preoperative multiple imaging examinations are helpful to observe the growth pattern and internal components of mediastinal angiolipoma and is helpful for diagnosis and differential diagnosis.

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  • 血管脂肪瘤最早于1960年被Howard和Helwig[1]报道,是一种少见的良性肿瘤,是脂肪瘤的一种变异体,占脂肪瘤的5%~17%[2-3]。血管脂肪瘤主要由成熟的脂肪组织和毛细血管组成,常发生于四肢和躯干的皮下组织,主要表现为多发的疼痛皮下结节,直径常小于2 cm[4]。发生在纵膈的血管脂肪瘤非常少见,临床症状不明确,术前影像学检查显示病灶内含脂肪组织是最主要的特征,但病理组织学是确诊纵隔血管脂肪瘤主要手段。目前国内外文献大多数报道CT、MRI的影像学特征,但99Tcm-MIBI SPECT/CT亲肿瘤显像尚未见报道,我们现对1例纵隔血管脂肪瘤99Tcm-MIBI SPECT/CT亲肿瘤阳性显像进行报道。

1.   患者资料
  • 患者男性,46岁,5 d前因胸闷气促不适至我院,门诊查胸部CT提示:前纵隔占位。为进一步治疗,门诊以“前上纵隔肿物”收治入院,拟行手术切除。入院体格检查:体温36.6℃,心率88次/min,呼吸18次/min,血压123/75 mmHg,神志清楚,双侧瞳孔等大且圆,光反射灵敏。双侧胸廓无畸形,双侧呼吸动度一致,语颤对等,双肺扣诊呈清音,听诊呼吸音清,未闻及干湿性啰音。实验室检查:血常规、肝肾功能及肿瘤指标均在正常范围内。胸部CT检查(图 1中A~C)显示,前上纵隔见一不规则肿块影,密度欠均匀,内可见脂肪密度影,边界清晰,大小约7.9 cm×4.1 cm;增强扫描后肿块不均匀轻度强化。为了解前纵隔肿物良恶性行99Tcm-MIBI SPECT/CT肿瘤显像。使用飞利浦公司Precedence型SPECT/CT(16排)仪,配低能通用平行孔准直器,能峰140 keV,窗宽20%,经左侧肘静脉注射925 MBq 99Tcm-MIBI(上海欣科医药有限公司苏州分公司提供,放射化学纯度>95%)后20、120 min时分别行SPECT/CT显像(连续采集360°,双探头各旋转180°,步进6°,20 s/帧,Zoom 1.0)(图 1中D、E)。结果显示,前纵隔肿物未见明显放射性异常。术后病理结果(图 1中F)为血管脂肪瘤。

2.   讨论
  • 血管脂肪瘤是一种少见的成熟良性脂肪肿瘤,主要发生在四肢和躯干的皮下组织,位于纵隔者罕见,其病理改变主要有大量成熟的脂肪细胞和增生的毛细血管组成,分为侵袭性和非侵袭性两种类型[2-3]。本例患者CT显示前纵隔团块状软组织密度影,内可见脂肪组织密度影及点状钙化灶,增强后病灶轻度强化,提示病灶为乏血供肿瘤。99Tcm-MIBI是亲脂性阳离子型非特异性亲肿瘤显像剂,依赖细胞膜和线粒体膜两侧的跨膜电位差进入细胞,主要聚集在线粒体内,恶性肿瘤细胞代谢旺盛,致使线粒体膜及胞质转运膜具有更高的电位差,从而导致恶性肿瘤细胞持续摄取99Tcm-MIBI[5]。早期相主要反映肿瘤组织血流灌注与肿瘤细胞摄取99Tcm-MIBI的量,延迟相与肿瘤细胞线粒体清除99Tcm-MIBI的速率有关[6]。本例患者99Tcm-MIBI亲肿瘤早期及延迟显像未见明显放射性异常,说明为乏血供和低代谢肿瘤。而本例患者99Tcm-MIBI亲肿瘤早期及延迟显像未见明显放射性异常,提示肿瘤为良性病变。有学者报道1例血管脂肪瘤18F-FDG PET显像,结果显示无明显18F-FDG摄取,这说明血管脂肪瘤为低代谢良性肿瘤[7]

    纵隔血管脂肪瘤罕见,结合本例患者特点,其鉴别诊断需与纵隔胸腺瘤、畸胎瘤、淋巴瘤等常见肿瘤相鉴别。胸腺瘤是前上纵隔最常见肿瘤,约占成人前上纵隔肿瘤的50%[8],可分为非侵袭性和侵袭性两种类型。非侵袭性胸腺瘤CT表现为圆形、卵圆形或分叶状肿块,边缘清晰,增强CT扫描可见肿块轻度强化;侵袭性胸腺瘤CT表现为边缘不清的不规则肿块,密度不均,增强扫描时强化较明显[9]。而本例患者表现为类圆形肿块,边缘光滑,增强扫描后肿块轻度强化且含有脂肪密度影,99Tcm-MIBI亲肿瘤阳性显像未见明显摄取,因此不难与胸腺瘤相鉴别。纵隔畸胎瘤是较常见的纵隔肿瘤,在原发性纵隔肿瘤中,其发病率仅次于胸腺瘤,其影像学表现分为囊性、实性或囊实混合性3种类型,CT常以脂-液平面、钙化、骨化、水样成分、液态脂质成分等混合密度影为特异性表现[10]。本例患者虽然含有多发点状钙化灶,但不难与畸胎瘤特征性钙化的CT表现相鉴别。

    本病例提示我们在临床纵隔肿块鉴别诊断中,含有脂肪成份及99Tcm-MIBI亲肿瘤阳性显像无高代谢的肿块,应想到有血管脂肪瘤的可能性。血管脂肪瘤的确诊主要依靠病理组织学,但术前多种影像学检查有利于观察肿瘤的生长方式、内部成份等,故综合多种影像学信息,有助于纵隔肿块的诊断及鉴别诊断。

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