骨肉瘤骨膜异常的影像表现与病理研究

目的 总结骨肉瘤骨膜异常的类型和影像特点,探讨骨肉瘤骨膜异常的病理基础.方法 经手术病理证实的骨肉瘤128例,男76例,女52例.年龄5～66岁,平均19岁.全部患者均经X线及MR检查,其中MR平扫加增强109例,扩散成像23例;CT检查48例,36例加行增强扫描;病理大体标本、大切片及定位取材常规切片共14例.将影像检查结果与手术、病理结果进行对照分析.结果 影像和病理表现:(1)骨膜水肿96例,只能在MRI上显示.病理上表现为骨膜结构疏松,无肿瘤细胞浸润.(2)骨膜掀起、增厚,可在CT、MRI上显示,但以MRI敏感(CT显示13例,MRI显示42例).病理上为骨膜掀起、增厚,无肿瘤浸润.(3)无骨膜新生骨的骨膜破坏48例,只能在MRI上显示.病理上为灶性或整个骨膜被肿瘤浸润.(4)线状骨膜新生骨,X线片、CT及MRI上各显示42、13及22例.病理上骨膜新生骨呈单层排列.(5)层状骨膜新生骨,X线片、CT及MRI上各显示21、6及21例.病理上,新生骨小梁呈多层排列.(6)放射状骨膜新生骨,X线片、CT及MRI上各显示13、7及14例,在X线片、CT上,越近病变中心针状影越长、密度越高.病理上,针状影间为肿瘤组织.(7)混合型骨膜新生骨,X线片、CT及MRI上各显示7、4及8例.为2种或2种以上的骨膜新生骨的混合表现.结论 (1)骨肉瘤可引起多种形态的骨膜异常,不同骨膜异常有不同的影像表现及病理基础.(2)所提出的对骨膜异常的分类,以病理所见为基础,较好地概括了骨膜各种病理改变的3种影像表现.(3)MRI可显示X线片、CT不能显示的骨膜水肿、无骨膜新生骨的骨膜破坏等更早期的骨膜异常,显示骨膜掀起、增厚也较CT更敏感.

Periosteal anomaly in osteosarcoma:the imaging findings and its pathological basis

Objective To summarize the types and imaging features of periosteal anomaly in osteosarcoma.Further to seek the feature of genesis and advancement of periosteal anomaly and its clinical significance.Methods One hundred and twenty-eight patients with osteosarcoma were enrolled in this study,which consisted of 76 males and 52 females aging from 5 to 66 years old with an average of 19 years.Both x-ray plain film and MR images were obtained in all patients.and DWI were done in 23 patients.CT scanning was conducted in 48 patients.which included post-contrast scanning done in 36.The pathological gross specimen,macrosection and point-to-point microsection were obtained in each of 14 cases to correlate the imaging findings of periosteal anomaly to the pathological outcome.Results The imaging and pathological finding:(1)Periosteodema,occurring in 96 patients.The sign was merely demonstratable on MR image and presented as loosened periosteal structure with no tumoral infiltration pathologically.(2)Periosteal lift and thickening,demonstratable on both CT and MR image,including 13 noted on CT and 42 on MR image.Pathologically,non-tumoral infiltration was noted in the thickened periosteum.(3)Periosteal destruction,occurring in 48 patients.Periosteal destruction was merely demonstratable on MR image and presented as localized or generalized tumoral infiltration of the periosteum.(4)Linear periosteal neo-bone formation,demonstrated in 42 cases on plain films,13 cases on CT and 22 on MR images,respectively.The linear periosteal neo-bone formation was pathologically regularly arranged periosteal neo-bone.(5)Laminar periosteal neo-bone fomarion,demonstrated in 21 cases on plain films,6 cases on CT and 21 on MR images,respectively.Pathologically,it appeared as multi-layer arrangement.(6)Radiated and spiculate periosteal neo-bone formation,demonstrated in 13 cases on plain films,7 cases on CT and 14 on MR images,respectively.On both plain film and CT,the closer to the center of the tumor,the longer and denser the spicule was.The interspiculate structure was tumoral tissue pathologically.(7)Periosteal neo-bone formation of mixed type,demonstrated in 7 cases on plain films,4 cases on CT and 8 on MR images,respectively.It was composed of 2 types or more of periosteal neo-bone.Conclusions (1)Multiform periosteal anomaly can be induced by osteosarcoma,and difierent periosteal anomaly possesses different imaging findings and different pathological basis.(2)The pathologically-based classification of periosteal anomaly generalizes the 3-modality imaging findings of various periosteal pathological alterations.(3)MR imaging enables to demonstrate periosteal anomaly more early,and periosteodema and periosteal destruction without neo-bone formation can only be demonstrated by MR imaging.MR imaging is more sensitive than CT in displaying periosteal thickening.