骨巨细胞瘤合并动脉瘤样骨囊肿的影像学表现分析

目的：探讨骨巨细胞瘤（GCT）合并动脉瘤样骨囊肿（ABC）的影像学表现及鉴别特点,以提高其诊断水平。方法：回顾性分析经手术、病理证实的14例GCT合并ABC的影像学表现。所有患者均行X线检查,11例行CT检查,12例行MRI扫描,2例行全身骨显像。对其影像学表现和病理结果进行对照。结果：14例中,病灶位于股骨6例,胫骨3例,尺骨3例,腓骨1例,桡骨1例。X线及CT表现为膨胀性骨质破坏,病灶密度不均匀,皮质变薄或中断。肿瘤实质区T₁WI呈等或低信号、T₂WI呈以高信号为主的混杂信号,病灶内多伴囊变和液-液平面,病灶周围骨质水肿,增强扫描病灶大部分呈明显强化。全身骨现象主要表现为病变部位片状放射性核素浓聚,显影不均匀。结论：GCT合并ABC的CT、MRI表现具有一定特征,结合X线、全身骨显像检查,有助于提高该病的术前诊断准确率,为临床治疗方案的制订提供帮助。     

直方图分析鉴别骨巨细胞瘤与动脉瘤样骨囊肿

【摘要】目的：探讨CT直方图分析技术在鉴别骨巨细胞瘤（GCT）和动脉瘤样骨囊肿（ABC）中的价值。方法：回顾性分析经术后病理证实的63例GCT和31例ABC的CT平扫图像。由两名具有3年经验的放射科医生分别通过CT图像评估肿瘤的形态特征,并对肿瘤整体绘制感兴趣区（ROI）获得直方图特征。采用卡方检验、独立样本t检验或Mann-Whitney U检验对两组数据进行比较,针对差异有统计学意义的特征进行二元Logistic回归及受试者操作特征（ROC）曲线分析,构建临床模型、直方图模型及联合模型,并分别与低年资和高年资放射科医生的诊断效能进行了对比。结果：骨巨细胞瘤和动脉瘤样骨囊肿的年龄、3个形态特征（病变位于膝关节周围、生长模式、具有液-液平面）及7个直方图特征（平均值、第90、95百分位数、不均匀性、峰度、熵、标准差）的差异具有统计学意义（P＜0.05）,其中年龄、具有液-液平面、峰度及标准差被纳入二元Logistic回归模型,临床模型、直方图模型、联合模型和低年资医生、高年资医生的AUC值分别为0.785、0.777、0.880、0743和0.863。结论：CT直方图分析技术在鉴别骨巨细胞瘤和动脉瘤样骨囊肿中具有重要价值,联合临床特征可进一步提高诊断效能,联合特征模型的效能显著优于低年资医生,并可于高年资医生相媲美。     

动脉瘤样骨囊肿误诊为骨巨细胞瘤1例分析

患者,男性,30岁,近2年来感右大腿疼痛,活动后加重,2周前由于剧烈运动后右下肢活动不能,遂入我院就诊。查体:右股骨上段压痛明显,皮肤稍显红肿,右髋活动受限。X线平片见:右股骨上段粗隆间呈多发皂泡样囊状透光区,周围有密度较高的硬化边缘,病灶内有残余骨嵴,后外缘皮质变薄,轻度膨胀,未见骨膜反应,毗邻骨边界尚清晰。初步诊断:右股骨上段骨巨细胞瘤(继发病理性骨折)。手术所见及病理诊断:囊肿由薄层囊状骨壳组成,上覆盖骨膜和由骨膜形成的薄层骨壁,囊腔内充满大量海绵状血池,其中多数充以暗红色血液。病理诊断:动脉瘤样骨囊肿。1　讨　论1 1…     

跟骨动脉瘤样骨囊肿1例

发生于跟骨的肿瘤和肿瘤样病变少见.现报告经手术及病理证实的1例跟骨动脉瘤样骨囊肿.     

动脉瘤样骨囊肿的影像学诊断

目的：探讨动脉瘤样骨囊肿（ABC）的影像学特点。资料与方法：回顾性分析23例经手术病理证实的ABC的影像学表现，23例均摄X线平片和CT平扫。4例行MRI检查。结果：23例ABC发生于长骨18例，骨盆5例。ABC平片表现常为偏心性膨胀性骨破坏；CT平扫可见膨胀的骨壳内缘呈清晰弧形压迹，其中骨壳完整12例，断缺11例。病灶密度不均，19例可见蜂房样低密度影或液－液平面，15例出现软组织肿块；4例MRI主要表现为T1WI呈等低信号，T2WI呈大小不一高信号囊腔或液－液平面，3例增强扫描，2例无明显强化，1例轻度强化，囊间隔在T1WI、T2WI及增强后均为低信号。结论：X线平片简便经济，但对内部结构的显示有一定限度，CT和MR对内部结构及软组织的显示明显优于前者，对ABC具有很高的诊断价值。     

楔状骨动脉瘤样骨囊肿一例

患者　女 ,2 4岁。 1年前右足背被砸伤 ,虽感疼痛 ,但未作处理 ,后自愈。约半年前又感右足背隐痛 ,并逐渐肿胀 ,当地摄片诊断为骨肿瘤。近日疼痛加重入我院 ,Ｘ线平片示 :右足第 1楔骨呈蛋壳状膨胀性改变 ,周围骨壳不完整 ,未见骨膜反应 ,其内未见明显钙化、骨嵴或分格。ＣＴ横断及冠状位扫描均见右第 1楔骨明显膨胀性破坏 ,失去正常骨外形 ,内缘骨皮质增厚 ,有中断 ,下外缘骨皮质变薄及多处中断 (图 1) ,骨内结构完全消失 ,但可见多个宽窄不一的液平面 (图 2 ) ,软组织不肿胀 ,第 2楔骨内缘受侵蚀。诊断 :右足第 1楔骨动脉瘤样骨囊肿 ,第 2…     

肋骨动脉瘤样骨囊肿1例

1．病理报告 男28岁。左侧胸部不适数年，近3个月局限性疼痛，肿胀、压痛明显加重；病情发展较快。体检：左侧胸部第10后肋骨处局部隆起，可扪及包块，质硬，肋骨受累。肺部听诊，未闻及干湿罗音。胸部X线检查：左侧第10后肋骨沿骨的长轴呈囊状膨胀，囊内有淡而粗的皂泡状结构阴影。骨皮质变薄，边缘清晰锐利并伴有硬化。X线诊断意见：左侧第10后肋骨动脉瘤样骨囊肿。     

骨巨细胞瘤的影像学诊断

目的探讨骨巨细胞瘤的X线平片、CT、MRI影像学表现。方法回顾分析经手术病理证实17例骨巨细胞瘤的影像学表现。结果 10例发生于长骨骨端(胫骨上端3例、股骨下端7例),以偏心性、膨胀性骨质破坏为主,周围无明显骨质硬化,内无钙化;7例发生于脊柱(颈椎1例、胸椎2例、骶椎4例),以膨胀性骨质破坏为主,发生于骶椎者,多位于骶椎1～2水平(2例位于骶1,2例位于骶2)。结论 X线平片结合CT、MRI能显著提高骨巨细胞瘤诊断准确率,对临床制定手术方案有重要意义。     

骨巨细胞瘤的影像学诊断

目的：探讨骨巨细胞瘤的平片、CT、MRI影像学表现,评价其诊断价值。方法：对16例经临床手术病理学证实的骨巨细胞瘤病例的X线平片、CT和MRI影像学资料进行回顾性分析。结果：9例长骨病灶分布主要在骨性关节面下方,以偏向性膨胀性骨破坏为主,周围硬化不明显,中央无钙化;增强后有不均匀强化效应;其中2例合并动脉瘤样骨囊肿者见液-液平面。7例脊柱和不典型部位病灶以膨胀性骨破坏为特点,周围硬化不明显,脊柱病灶同时见周围软组织肿块形成,中心无钙化;其中1例脊柱病灶同时累及相邻三个椎体。骶椎病灶分布位置偏高,在骶椎1～2水平。结论：大多数骨巨细胞瘤有典型的X线表现,不难作出正确的诊断;CT和MILI能提供更多的信息来提高诊断和鉴别诊断能力。     

骨纤维结构不良继发动脉瘤样骨囊肿影像诊断

目的探讨CT与MRI对骨纤维结构不良继发动脉瘤样骨囊肿的诊断价值。方法对12例病理证实的骨纤维结构不良继发动脉瘤样骨囊肿CT及MRI资料进行回顾性分析。其中6例行CT检查,4例行MRI检查,另有2例分别行CT及MRI检查。结果单骨型11例,其中股骨5例,肱骨4例,腓骨1例及桡骨1例;多骨型1例,同时累及髋臼、坐骨支及股骨。在CT上可见病变不同程度膨胀,5例成单囊状或多囊状改变,3例成囊实性改变,实性部分呈磨玻璃样改变。在MRI上,6例均呈囊实性改变,实性部分在T1WI上呈均匀或不均匀低、等信号,在T2WI上呈均匀或不均匀低、等或高信号,增强扫描后呈轻或中度强化,其囊性部分呈T1WI低信号及T2WI高信号改变,骨皮质变薄,3例囊内见分隔,1例见液-液平面,增强扫描后仅有囊壁及囊内分隔强化。结论 MRI对骨纤维结构不良继发动脉瘤样骨囊肿诊断比CT有优势,但作出准确的术前诊断仍需结合X线或CT。     

不规则骨骨巨细胞瘤的MRI诊断

目的:分析不规则骨骨巨细胞瘤的MRI征象,提高对不规则骨骨巨细胞瘤影像学表现的认识及鉴别诊断水平.方法:结合文献对7例经手术病理证实的不规则骨骨巨细胞瘤的MRI影像表现进行分析.结果:MRI主要影像表现为膨胀性改变、溶骨性破坏及软组织肿块.病变在T1WI呈等或低信号,T2WI为低到高不均匀信号.结论:MRI检查对不规则骨骨巨细胞瘤的诊断和鉴别诊断具有明显的价值,并为临床手术提供可靠的资料.     

Multicentric giant cell tumor: report of five new cases

The typical giant cell tumor (GCT) is a solitary neoplasm that occurs in the epiphysis or epimetaphysis of long bones. GCT is seen with a slightly increased frequency in females, and 70% of patients are between 20 and 40 years of age at the time of presentation. Multicentric giant cell tumor (MGCT; two or more centers) is an unusual variant of GCT. Patients with MGCT are likely to be younger than those with a solitary lesion. The multicentric variety is often of a higher stage at diagnosis and is more often associated with a pathological fracture than the unifocal tumor. We are reporting five new cases of MGCT, with a total of 21 tumors seen over a period of 25 years from 1967 to 1992.     

The role of magnetic resonance imaging in giant cell tumor of bone

In six cases of giant cell tumor the magnetic resonance (MR) images obtained with various pulse sequences and field strengths were compared to the corresponding computed tomography (CT) scans and plain roentgenograms. MRI was superior to CT and plain films in demonstrating areas of tissue inhomogeneity within the tumor as well as soft tissue extension. CT was superior in demonstrating cortical thinning. Multiplanar imaging capability and visualization of articular cartilage may demonstrate intra-articular tumor spread. The characteristic MRI findings with short TR/TE (T1-weighting) and long TR/TE (T2-weighting) are described. We also describe one case where serial MR scans were used to assess response to therapy.     

骨巨细胞瘤的X线诊断

目的：探讨骨巨细胞瘤的X线诊断。方法：搜集我院1980年至今经病理证实的骨巨细胞瘤43例,所有病例均行常规X线检查。分析骨巨细胞瘤的X线的影像表现,并探讨其误诊原因。结果：本组43例中,发生于股骨12例,胫腓骨9例,肱骨4例,尺骨1例,脊柱10例,跟骨1例,肩胛骨2例,肋骨2例,指骨1例,蝶骨1例。35例呈膨胀性生长,其中合并病理性骨折9例,本组术前误诊11例,约占25.6%。病理诊断为恶性骨巨细胞瘤11例。结论：常规X线由于其空间分辨率高,可以清晰的反映骨肿瘤影像的大体形态,是诊断骨肿瘤的重要和首选检查方法。     

腱鞘巨细胞瘤的影像学分析

目的 分析腱鞘巨细胞瘤(giant cell tumor of tendon sheath,GCTTS)的影像学表现以增加对该病的影像学认识,提高影像诊断的准确率.方法 收集2009年9月～2012年11月14例经手术病理组织证实的GCTTS患者X线、CT、MRI影像进行回顾性分析.其中14例行X线平片检查,6例行CT平扫检查,8例行MRI平扫及增强扫描.结果 X线平片显示局部稍高密度软组织肿块影,邻近骨质未见明显异常或轻度侵蚀破坏;CT表现为关节周围肌间隙内局限性软组织肿块,部分呈分叶状,明显跨关节生长,无明显钙化征象及骨膜反应;MRI表现为病灶在T1WI多呈较低信号,内可见条片状更低信号影,T2WI呈高低混杂信号,增强后强化明显,病灶与邻近肌腱关系密切,局部骨皮质可受侵.结论 腱鞘巨细胞瘤的影像学表现具有一定的特征性.     

Triple-phase dynamic MRI: A new clue to predict malignant transformation of giant cell tumor of bone

Objective

Our purpose was, through the comparison of the characteristics of time–intensity curve on triple-phase dynamic contrast-enhanced MRI among groups of giant cell tumor of bone (GCTB), recurrent benign giant cell tumor of bone (RBGCTB), and secondary malignant giant cell tumor of bone (SMGCTB), to find clues to predict the malignant transformation of GCTB.

Subjects and methods

21 patients diagnosed as GCTB were included in this study. All cases took recurrence after intralesional curettage. 9 cases were confirmed as SMGCTB and 12 cases were confirmed as RBGCTB. Cases were divided into four groups: group A, GCTB (n = 9); group B, SMGCTB (n = 9); group C, GCTB (n = 12); group D, RBGCTB (n = 12). Enhancement index(EI) of lesions on DCEMRI was calculated using formula: EI(t) = [S(t) − S(0)]/S(0), where S(0) was signal intensity of lesion on non-contrast-enhanced T1-weighted images and S(t) was signal intensity of lesion on DCEMRI (t = 30, 60, 180 s). Enhancement index of each group in each phase was compared using One-Way ANOVA analysis. Slope values of time–intensity curve were compared by the same way.

Results

Time–intensity curve of SMGCTB was characterized by a steep upward slope followed by an early and rapid washout phase. Time–intensity curve of GCTB and RBGCTB was characterized by a steep slope followed by a relatively slow washout phase. No significant difference in enhancement index was found in the first phase (p > 0.05). There was significant difference in the second and the third phase (p < 0.05). Enhancement index of group B (SMGCTB) was smaller. There was no difference in rising slope value (p > 0.05).

Conclusions

Dynamic contrast-enhanced MRI appears a helpful method to find new clues to predict malignant transformation of GCTB.