骨盆骨巨细胞瘤影像特征分析

目的:分析骨盆骨巨细胞瘤X线平片、CT及MRI征象,探讨其影像特征及鉴别诊断要点。方法:分析总结经手术及病理证实的29例(包括7例复发)骨盆骨巨细胞瘤患者的X线平片、CT、MRI表现。结果:①X线平片表现:囊状骨质破坏15例,单纯溶骨性破坏8例,"多房性"骨质破坏6例。②CT表现:18例呈囊样膨胀性骨质破坏,11例呈单纯溶骨性破坏,未见骨膨胀扩张征象;增强扫描肿瘤实质部分均出现轻度至中度的强化。③MRI表现:6例MRT1WI上均呈等信号、低信号,T2WI上呈低信号、等信号、高混杂信号。结论:骨盆巨细胞瘤的影学表现为膨胀性溶骨破坏,与长骨巨细胞瘤比较除膨胀更为显著外,余无明显差异;骨盆骨巨细胞瘤诊断需综合运用X线平片、CT及MRI并与临床表现相结合,且能够提高骨盆骨巨细胞瘤诊断及鉴别诊断的准确性。     

腱鞘巨细胞瘤的MRI诊断(附10例分析)

目的 探讨腱鞘巨细胞瘤的MRI表现,提高对该病的诊断准确率.方法 回顾性分析10例经手术病理证实的腱鞘巨细胞瘤的MRI资料.所有病例行MR平扫,其中4例同时行增强扫描,总结其MRI表现特点.结果 在10例腱鞘巨细胞瘤中,局限型8例,弥漫型2例,病变位于足底部3例,位于腕和踝关节各2例,位于手指、肘和膝关节各1例.所有病例均可见软组织肿块紧贴或包绕肌腱生长,在T1WI上有6例肿块和骨骼肌对比呈等信号,有2例稍低信号,有2例等低信号;在T2WI上肿块和骨骼肌对比有3例呈等信号,5例呈高低混杂信号,2例呈低信号.增强扫描后3例不均匀中等强化,1例呈均匀明显强化.其中2例弥漫型腱鞘巨细胞瘤可见邻近骨质侵蚀.结论 MRI对腱鞘巨细胞瘤具有较高的诊断价值,应作为首选的检查方法.     

骨巨细胞瘤影像学

骨巨细胞瘤是一种常见的骨原发性肿瘤，本文通过对文献的复习，系统地介绍骨巨细胞瘤的临床、病理、X线、CT和MRI的表现特点，认为骨巨细胞瘤的影像学表现有一定的特征性，典型的X线表现为长管骨骨端偏心性、膨胀性、皂泡样、达关节软骨下骨边界清楚的溶骨性骨质破坏；典型的CT表现为骨端偏心性、膨胀性、溶骨性骨质破坏，骨皮质变薄，连续性完整或栅栏状中断，肿瘤的边缘可有程度不等、断续的骨质硬化，肿瘤内可见有短小的骨嵴；典型的MRI表现为长骨骨端偏心性、达关节软骨下骨的异常信号区，T1WI为中等信号，T2WI为中、高信号混杂，可出现液一液平，肿瘤的边缘有一相对比较规则的、由于周围骨质硬化引起的T1WI及T2WI均为低信号的线状影；影像学检查对于骨巨细胞瘤的诊断、鉴别诊断及治疗后随访均有重要的价值。     

胸椎骨巨细胞瘤的影像学表现

目的：分析胸椎骨巨细胞瘤的 X 线、CT 和 MRI 影像学特点,提高本病的影像诊断及鉴别诊断能力。方法收集经手术病理证实的9例胸椎骨巨细胞瘤患者的 X 线、CT 和 MRI 资料并对其回顾性分析。7例行 X 线检查,6例行 CT 检查,7例行 MRI检查。结果9例胸椎骨巨细胞瘤中,8例单椎体发病,1例同时累及左侧第9后肋。X 线检查：6例呈溶骨性骨质破坏,1例呈膨胀性骨质破坏;3例边界清楚,3例病变椎体变扁,4例周围见软组织肿块形成。CT 检查：5例呈溶骨性骨质破坏,1例呈膨胀溶骨性骨质破坏;3例边界清楚并可见少许硬化边,4例内见骨嵴影,5例周围见软组织肿块,椎附件、硬膜囊及脊髓不同程度受累及。MRI检查：T1 WI 低信号 5例,等信号2例;T2 WI 等信号 1例,高信号 4例,高低混杂信号2例。结论胸椎骨巨细胞瘤较为少见,应充分分析影像学特点,对提高诊断、指导临床手术治疗及预后有重要的意义。     

颅骨骨巨细胞瘤的影像诊断

目的 探讨颅骨骨巨细胞瘤(GCT)的CT、MRI征象, 提高对本病的认识.方法 回顾性分析经手术病理证实的5例颅骨GCT的CT、MRI表现, 5例患者均行普通CT平扫,2例行CT增强扫描;3例以颞骨破坏为主的病例,均行颞骨MRI平扫、增强扫描及HRCT扫描及听骨链、面神经计算机重建.结果 5例均单侧发病, 右侧4例、 左侧1例.CT平扫显示广泛的膨胀性骨质破坏、残存骨嵴及骨包壳.肿瘤信号多变,在T1WI呈低-等信号;在T2WI肿瘤呈不均匀的高信号,病灶周边T2WI呈现特征性的低信号,增强扫描:实性部分表现为不均匀强化.结论 颅骨GCT的CT平扫显示广泛的膨胀性骨质破坏不伴硬化边、残存骨嵴及骨包壳,T2WI病灶周边低信号是本病的特征性影像学表现;颞骨HRCT扫描及听骨链、面神经CPR重建为术前评估听小骨、面神经受累情况,为临床制定治疗策略提供更准确的影像信息.     

颅底骨巨细胞瘤的CT、MRI表现

目的:探讨颅底骨巨细胞瘤的CT、MRI表现。方法:回顾性分析11例经手术病理证实的颅底骨巨细胞瘤的临床表现及CT、MRI表现。结果:11例病变均位于颞骨和蝶骨,CT表现为不规则混杂密度软组织肿块,相应颅骨呈溶骨性和膨胀性骨质破坏,肿块外周多有骨性包壳存在。肿瘤MRI信号不具特征性,但MRI检查有助于观察病灶与周围软组织、血管、神经的关系。CT、MRI增强扫描后肿块均表现为不均匀强化。结论:CT和MRI表现有助于颅底骨巨细胞瘤的诊断和鉴别诊断,并为制定治疗方案提供详细资料。     

颅底骨巨细胞瘤的CT、MRI表现

目的:探讨颅底骨巨细胞瘤的CT、MRI表现。方法:回顾性分析11例经手术病理证实的颅底骨巨细胞瘤的临床表现及CT、MRI表现。结果:11例病变均位于颞骨和蝶骨,CT表现为不规则混杂密度软组织肿块,相应颅骨呈溶骨性和膨胀性骨质破坏,肿块外周多有骨性包壳存在。肿瘤MRI信号不具特征性,但MRI检查有助于观察病灶与周围软组织、血管、神经的关系。CT、MRI增强扫描后肿块均表现为不均匀强化。结论:CT和MRI表现有助于颅底骨巨细胞瘤的诊断和鉴别诊断,并为制定治疗方案提供详细资料。     

腱鞘巨细胞瘤的影像学表现

目的分析和总结腱鞘巨细胞瘤(GCTTS)的影像学表现。方法分析20例GCTTS患者X线、CT、MRI影像及病理资料,所有患者经病理或手术证实。10例行X线检查,9例行CT平扫检查,4例同时行增强检查,2例同时行关节CT造影检查,19例行MRI平扫。结果7例X线平片骨质破坏,2例仅见关节周围软组织肿胀,骨质见硬化边,关节间隙正常,均未见钙化及骨膜反应。CT平扫关节周围等密度肿块,密度不均匀,边缘不清楚;8例见明显骨质破坏;1例骨质可见硬化边,均未见钙化及骨膜反应。关节CT造影及增强扫描肿块呈中度至明显的不均匀强化。T1WI 14例与骨骼肌信号对比呈等信号,内见斑点状低信号,5例呈稍低信号;T2WI与骨骼肌信号对比13例呈混杂信号,内见线条状低信号,6例呈高信号。结论GCTTS的影像表现有一定的特点,X线、CT显示邻近骨质压迫吸收、侵蚀性改变,MRI能够反映GCTTS内部的双低信号特征。     

手部局限型腱鞘巨细胞瘤MRI表现

【摘要】目的：探讨手部局限型腱鞘巨细胞瘤MRI表现。方法：回顾性分析经手术和病理学诊断的32例手部局限型腱鞘巨细胞瘤患者,术前均进行了MRI检查,记录肿物的位置、大小、形态、边界、信号和周围组织的关系等情况,以病灶最大径15mm为界,分A（最大径≤15mm）、B（最大径﹥15mm）两组,对两组患者年龄、病灶形态、脂肪抑制T2WI/PDWI信号、与邻近肌腱或骨质关系、骨质侵犯情况的差异进行比较,并做统计学分析。结果：32例病理确诊的局限型腱鞘巨细胞瘤表现为肌腱旁、关节周围或包绕肌腱的实性肿物,信号多混杂,形态规则6例,不规则26例,邻近骨质侵犯2例。A、B两组在年龄、病灶形态、脂肪抑制T2WI/PDWI信号、与邻近肌腱或骨质关系差异有统计学意义（P<0.05）,骨质侵犯情况差异无统计学意义（P>0.05）。结论：MRI检查能够显示手部局限性腱鞘巨细胞瘤的信号特征、范围及其与周围组织结构的关系,肿块最大径超过15mm时,脂肪抑制T2WI/PDWI信号更混杂,更容易包绕邻近肌腱或骨质。     

腱鞘巨细胞瘤与色素沉着绒毛结节性滑膜炎的MRI表现

目的:分析腱鞘巨细胞瘤与色素沉着绒毛结节性滑膜炎的MRI表现特点.方法:回顾性分析28例(腱鞘巨细胞瘤17例、色素沉着绒毛结节性滑膜炎11例)经手术病理证实的病例资料,所有病例均行MRI检查.结果:腱鞘巨细胞瘤位于膝关节3例,踝关节6例,腕关节2例,3例手部,3例足部.病变呈弥漫型11例,局限型6例.在T1WI上呈等低信号为主,在T2WI上以低信号为主,混杂斑片状等、高信号,伴肌腱、韧带侵犯11例,骨质破坏10例,关节积液7例.色素沉着绒毛结节性滑膜炎发生在膝关节9例,髋关节1例,踝关节1例,弥漫型9例,局限型2例.增生的滑膜在T1WI上呈中等或稍低信号,在T2WI上呈中等稍高信号,其内可见多发散在结节,呈T1WI、T2WI低信号灶,伴肌腱、韧带侵犯8例,骨质破坏6例,关节积液9例.结论:腱鞘巨细胞瘤与色素沉着绒毛结节性滑膜炎好发部位不同,但病灶具有相同的信号特征.     

Malignancy in giant cell tumor

Malignant giant cell tumor is a confusing term that in the past has been used to describe different types of giant cell-rich tumors. We try to clarify this term in this report. We consider two types of malignancy in giant cell tumor of bone: "primary" when it arises in juxtaposition to a benign giant cell tumor and 'secondary' when it arises at the site of a previously treated giant cell tumor. Here we present a case of primary malignancy in giant cell tumor that was initially not recognized as a malignancy. On radiography and histology of frozen sections the lesion had the appearance of a conventional giant cell tumor of bone. After curettage, the permanent histology slides showed areas of highly malignant osteosarcoma juxtaposed to areas of benign giant cell tumor. The patient was treated with chemotherapy and wide resection of the tumor.     

Scintigraphic features of giant cell tumor

The scintigraphic appearance of giant cell tumor of bone in six patients is presented. Patients were studied by means of Tc-99m MDP bone scanning. On early blood pool and delayed imaging, markedly increased activity was noted, characteristically displaying a "ring" pattern that is readily discernible from patterns seen in bone cysts and nonosteogenic fibroma. The extent of the lesion, as judged by scintigraphic techniques, was roughly equal to estimates of extent by other radiographic modalities. Only one example of a different lesion mimicking giant cell tumor was encountered in over 100 cases of a variety of primary bone neoplasms reviewed. We conclude that giant cell tumor has a characteristic scintigraphic appearance.     

Extraarticular paravertebral diffuse-type giant cell tumor

A diffuse-type giant cell tumor (DGCT) of the paravertebral region is a rare condition characterized by an ill-demarcated mass with facet joint involvement. We describe a case of extra-articular DGCT of the paravertebral cervical region without association to the facet joint. A 51-year-old male presented with a headache. Diagnostic imaging showed a dumbbell-shaped mass with enlargement of the right intervertebral foramen between C6 and C7. The tumor was completely resected in multiple fragments with the suspicion that it was a schwannoma. Histologically the tumor consisted chiefly of mononuclear histiocytoid cells, foamy macrophages and multinucleated giant cells, which led to a diagnosis of DGCT. The case alerts one to be aware that DGCT may originate from a paravertebral location as a soft-tissue mass without facet joint involvement.     

骨盆巨细胞瘤1例

患者 女，34岁。因右臀部疼痛及肿胀10个月，加重伴右下肢酸胀1周而入院。查体见右臀部肿胀及压痛明显．右髋关节活动受限，各项生化检查正常。     

Malignant giant cell tumor of soft parts

Giant cell tumor of soft parts (GCTSP) is an extremely rare lesion with an unpredictable behavior. Some patients are cured with a simple surgical excision whereas others will develop metastatic disease within a relatively short interval. To date, there are no consistently reliable criteria, either clinical or histologic, to separate the benign from more aggressive lesions. We describe the clinical, histologic and radiologic features of a case with malignant behavior. The patient presented with a fungating skin and soft tissue mass and concurrent pulmonary nodules. The lesion recurred rapidly despite wide resection with negative surgical margins. Biopsy of the pulmonary lesions demonstrated metastatic disease.     

Radionuclide bone scanning in giant cell tumor

Radionuclide bone scan findings are described and correlated with pathology in 23 patients with giant cell tumor (GCT) of the bone. The degree of radionuclide activity was markedly increased in 20 (87%), minimally increased in three (13%), and decreased in none of the patients. Of the 23 patients with increased radioactivity, the pattern was diffuse in 11 (48%) and doughnut in 12 (52%). Extended patterns of radioactivity were present in 19 of 22 patients; however, none were associated with true tumor extension. Bone scanning did not aid in the detection of GCT, was nonspecific, and did not differentiate benign from malignant GCT. Although radioactivity extended beyond the radiographic abnormality in the majority of patients, this was most likely secondary to other bony abnormalities or local and/or regional hyperemia, and caution should be taken in ascribing this extension to either tumor or metastasis.