【摘要】 目的 分析肌层脂肪瘤和各型脂肪肉瘤超声影像特征及鉴别诊断价值。方法 回顾性收集发生于躯干及四肢肌层且经病理证实为脂肪源性肿瘤的病人66例。根据肿瘤病理结果将病人分为脂肪瘤组（45例）和脂肪肉瘤组（21例）。观察肿瘤形态、边界、内部回声、回声均匀程度、低-无回声区、细分隔及血流信号分级，并记录肿瘤最大径。采用Mann-Whitney U检验及卡方检验比较2组病人临床资料及肿瘤超声声像特征的差异。采用受试者操作特征（ROC）曲线分析组间差异有统计学意义的超声参数，并计算曲线下面积（AUC）、敏感度和特异度。分析不同亚型脂肪肉瘤的超声声像特征。结果 相比于脂肪瘤组，脂肪肉瘤组病灶存在低-无回声区、存在细分隔及血流信号分级Ⅰ、Ⅱ级的占比更高，最大径更大（均P<0.05）。血流信号分级鉴别脂肪瘤与脂肪肉瘤的效能最佳（AUC=0.837）；最大径的敏感度最高（0.90），存在低-无回声区的特异度最高（0.91）。脂肪肉瘤的超声影像显示，高分化脂肪肉瘤多见细分隔，血流较少；黏液样脂肪肉瘤多表现为内部回声不均匀，存在低-无回声区，血流较丰富；未分化脂肪肉瘤多为高回声及低回声两区域，且分界清，血流信号较丰富；多形性脂肪肉瘤表现为高低混合回声，血流较丰富。结论 超声影像上肿瘤最大径、低-无回声区、细分隔、血流信号分级在鉴别肌层脂肪瘤和脂肪肉瘤时具有较高诊断价值。不同亚型的脂肪肉瘤超声表现不同。更多还原

【Abstract】 Objective To analyze the ultrasonographic features of intramuscular lipoma and various subtypes of liposarcoma and assess their value in differential diagnosis. Methods All of 66 patients with pathologically confirmed adipocytic tumors located in trunk or limb muscles were retrospectively analyzed. According to pathological results, patients were divided into a lipoma group(45 cases) and a liposarcoma group(21 cases). The tumor’s shape, boundary, internal echo,degree of echo uniformity, presence of hypoechoic/anechoic areas, fine septations and blood flow signal grading were evaluated. The maximum diameter of tumor was recorded. Differences in clinical data and ultrasound features between the two groups were compared using the Mann-Whitney U test and chi-square test. Ultrasound parameters with statistical significance were further analyzed using receiver operating characteristic(ROC) curve to determine the area under the curve(AUC), sensitivity, and specificity.The ultrasonic characteristics of different liposarcoma subtypes were also analyzed. Results Compared with the lipoma group, the liposarcoma group had a significantly higher incidence of hypoechoic/anechoic areas,fine septations, and grade Ⅰ-Ⅱ blood flow signals, and showed larger maximum diameters(all P<0.05). Blood flow signal grading demonstrated the best diagnostic efficacy(AUC =0.837) for distinguishing lipoma from liposarcoma, while the maximum diameter achieved the highest sensitivity(0.90), and the the presence of hypoechoic/anechoic area yielded the highest specificity(0.91). Ultrasonographically, well-differentiated liposarcoma often showed fine septations and sparse vascularity. Myxoid liposarcomas were characterized by heterogeneous internal echogenicity, with hypoechoic/anechoic areas and relatively abundant blood flow. Undifferentiated liposarcoma typically presented with hyperechoic and hypoechoic, with clear boundaries and relatively rich blood flow signals. Pleomorphic liposarcoma showed mixed echogenicity and relatively abundant blood flow. Conclusion Muscularis lipoma and liposarcoma have different ultrasonic characteristics, such as the maximum diameter, the presence of hypoechoic/anechoic region, the presence of fine septations, and the blood flow signal,which have high diagnostic value in differentiating between lipomas and liposarcomas. Different subtypes of liposarcoma exhibit distinct ultrasonic manifestations.更多还原