骨肉瘤的影像学研究进展

<正>骨肉瘤是最常见的原发恶性骨肿瘤之一,多发生于儿童和青少年,恶性程度高,预后差。早期诊断及治疗能有效改善患者预后。传统影像学诊断骨肉瘤已有较多研究,CT和MRI等现代影像学检查方法的出现,为早期发现骨肉瘤提供了可能,尤其是MRI检查,不仅能显示肿瘤内部特征及肿瘤浸润的范围,且在肿瘤治疗后的随访中起着重要作用。     

长骨骨干骨肉瘤X线、CT及MRI表现

目的 分析长骨骨干骨肉瘤X线、CT和MRI表现,探讨有关的临床特点和鉴别诊断.方法 28例长骨骨干骨肉瘤患者,均经手术与病理证实,其中病变位于股骨干18例、腓骨干4例、肱骨干4例、胫骨干2例.所有患者均行X线、CT和MR检查,对其影像学表现与手术病理结果进行对照,并由双盲法分析确认.结果 28例中,X线和CT显示广泛骨质破坏16例,骨膜反应22例.X线显示软组织肿块18例,肿瘤骨和瘤样钙化12例.CT平扫显示软组织肿块22例,增强扫描显示软组织肿块24例,肿瘤骨和瘤样钙化16例.MRI显示骨质破坏和骨膜反应10例,软组织肿块26例,其周围可见软组织水肿及骨髓水肿.骨膜反应在SE T1WI上呈等低信号,T2WI呈等信号.软组织肿块在T1WI为等信号,T2WI及STIR呈等高信号.软组织水肿及骨髓水肿在T2WI及STIR呈高信号.MRI增强检查显示病灶均呈不均匀强化,骨髓水肿和软组织肿块均见强化.结论 X线、CT和MRI从不同方面反映长骨骨干骨肉瘤的影像病理特点,其发病率低,骨破坏范围大,无病理性骨折.成骨型骨干骨肉瘤较易诊断,溶骨型应与Ewing瘤、恶性巨细胞瘤等鉴别.

Abstract：

Objective To explore the findings of diaphysial osteosarcoma in long bone on X-ray,CT and MRI, and discuss their clinical features and manifestations for differential diagnosis. Methods Twenty-eight cases with diaphysial osteosarcoma in long bone proved by surgery and pathology were reviewed retrospectively. Eighteen tumors were located in the femur, 4 in fibula, 4 in humerus and 2 in tibia. All of the patients were examined by X-ray, CT and MRI. The imaging manifestations on X-ray, CT and MRI were analyzed, and the relationship of the imaging features with the pathological types was also observed. The imaging signs were correlated with the pathologic findings with a double blind method. Results Of the 28 cases, there were 16 cases with large bone destruction, 22 cases with periosteal reaction on X-ray and CT. On X-ray, 18 cases showed soft tissue mass and 12 cases with neoplastic bone and tumor calcification.While on CT, 22 cases showed soft tissue mass on plain scan and 2 more cases displayed soft tissue mass after the injection of contrast mediun. Sixteen cases showed neoplastic bone and tumor calcification on CT.On MRI, there were 10 cases with bone destruction and periosteal reaction with iso- and hypo-intense on T1WI and iso- signals on T2WI. Twenty-six cases showed soft tissue edema and bone marrow on MRI. The soft mass were iso-signals on T1 WI and iso-hyperintense signals on T2 WI or STIR. The soft tissue edema was found hyperintense signals on T2WI or STIR. The lesions had heterogeneous enhancement especially in bone marrow with edema and adjcent soft tissue. Conclusion The X-ray, CT and MRI can reflect the pathological changes of diaphysial osteosarcoma in long bone from different aspects. Lower incidence, large bone destruction and no pathological fracture were the features of diaphysial osteosarcoma. The osteogenic type is diagnosed easily, but the osteolytic lesion should be differentiated from Ewing sarcoma, malignant giant cell tumor of bone and so on.     

不同病理类型骨肉瘤的影像学表现初探

目的：探讨不同病理类型骨肉瘤的X线、CT及MRI表现。方法：搜集经病理证实的23例骨肉瘤患者的影像学资料,其中23例均行X线检查,22例行CT检查,19例行MRI检查,分析其X线、CT及MRI表现。结果：23例中骨母细胞型骨肉瘤10例,均可见不同类型的瘤骨;纤维母细胞型骨肉瘤6例,以溶骨性破坏为主,部分病例见少量瘤骨;软骨母细胞型骨肉瘤5例,可见成簇分布的点状、环状的瘤骨,增强扫描呈环状／花边状／间隔强化;血管扩张型骨肉瘤1例;小圆细胞型骨肉瘤1例。结论：X线、CT及MRI对不同病理类型的骨肉瘤的诊断及鉴别诊断有一定作用。     

成年人骨肉瘤的临床及影像学特点(附33例分析)

目的:分析成年人骨肉瘤的临床和影像学特点.方法:回顾性分析33例30岁以上的骨肉瘤患者的临床和影像学资料,并与对照组和文献比较.探讨成年人骨肉瘤的发病率、病程、血清碱性磷酸酶水平、病灶分布特点、影像学特点及诊断正确率等.结果:成年人骨肉瘤占所有病例的15.6%,发病率随年龄升高而下降;病程较长,平均8.7个月;约33%的病例血清碱性磷酸酶水平正常,明显少于对照组;皮质旁骨肉瘤和骨干骨肉瘤的发病率较高,骨干骨肉瘤常见于邻近干骺端部位;与青少年相比,典型部位发病低而髋关节周围发病率高;骨质破坏类型(成骨型、溶骨型或混合型)无特殊性;特殊影像学表现多见,其中4例呈囊样骨破坏,病灶内囊变明显,肿瘤实质成分少.结论:成年人骨肉瘤诊断正确率低,容易误诊为骨巨细胞瘤、软骨肉瘤、转移瘤、其他恶性骨肿瘤、良性骨肿瘤甚至骨髓炎等.其临床和影像学特点与青少年不同,应引起重视.     

软骨母细胞型骨肉瘤的影像学表现及病理学基础分析

目的：探讨软骨母细胞型骨肉瘤的X线片、CT及MRI影像学表现和病理基础的相关性。方法：回顾性分析12例经病理证实的软骨母细胞型骨肉瘤X线片、CT及MRI片资料,并与病理结果结合分析。结果：软骨母细胞型骨肉瘤的影像学表现包括肿瘤骨、瘤软骨钙化、骨膜反应及软组织肿块。软骨母细胞型骨肉瘤的间隔强化和边缘强化区代表肿瘤的纯软骨成分。MRI增强扫描有利于软骨母细胞型骨肉瘤与软骨肉瘤的鉴别。结论：软骨母细胞型骨肉瘤容易误诊为软骨肉瘤,合理应用X线、CT、MRI检查,可提高软骨母细胞型骨肉瘤与软骨肉瘤鉴别诊断的准确性。     

原发性骨淋巴瘤的影像学表现

目的：分析原发性骨淋巴瘤（PLB）的影像学表现,以提高诊断准确率。方法：选择19例经病理证实的PLB患者。行X线检查8例,CT平扫19例,MRI平扫13例,MRI增强扫描6例。结果：19例中单骨受累16例,多骨受累3例。8例X线检查中,骨质破坏呈溶骨型6例,混合型2例。19例CT检查中,骨质破坏溶骨型16例,混合型3例,其中15例病变周围伴明显软组织肿块。病变在T₁WI上多呈等或稍低信号;T₂WI呈稍高信号,脂肪抑制T₂WI序列呈高信号;增强扫描多呈中度明显强化。结论：PLB的影像学表现具有一定的特征性,有助于PLB的诊断及鉴别诊断。     

肺外结核的影像学表现

肺外结核的诊断较困难,认识和熟悉其影像学表现,对诊断很有帮助.本文讨论了骨骼肌肉、中枢神经、腹部、淋巴结及乳腺等部位结核的影像学表现.     

滑膜肉瘤的影像学表现

目的:分析滑膜肉瘤的影像学表现,以提高对该病的认识。方法:回顾性分析11例经病理确诊为滑膜肉瘤患者的各种影像资料。结果:11例滑膜肉瘤发病部位分别位于足部(包括踝关节)4例,髋关节2例,胸椎2例,前肋骨、肱骨下段及臀部各1例。X线平片表现为类圆形、椭圆形或分叶状的软组织肿块,1例肿块近边缘出现斑点及斑片样钙化并伴有邻近骨质囊状破坏。CT表现为稍低于周围正常肌肉密度的不均匀软组织肿块,边界不清晰,增强扫描呈轻~中度不均匀强化。磁共振T1WI上,4例为等低信号,1例为稍高信号;T2WI上均呈中/高混杂信号,并见更高信号囊变区,T2WI压脂为不均匀高信号,部分呈多发结节样团块,并见低信号分隔,增强扫描呈明显不均匀强化。肿瘤具有侵袭性,位于臀部的病灶则向臀大肌、臀中肌及臀小肌侵犯。发生于胸椎附件区病灶邻近椎板及棘突骨质破坏,并沿椎间孔向椎管内突入。结论:滑膜肉瘤的影像学表现具有一定特征,对肿瘤的诊断也有帮助;但对于发生于罕见部位的滑膜肉瘤而言,仍有赖于病例组织学的检查。     

骨内腱鞘囊肿的影像学表现

目的:探讨骨内腱鞘囊肿的影像学表现及其诊断价值。方法:回顾性分析经病理证实的23例骨内腱鞘囊肿的临床及影像资料,X线平片检查15例,螺旋CT检查9例,MRI检查6例。4例同时行X线平片和CT检查,3例同时行X线平片和MRI检查。结果:X线、CT表现为骨内邻近关节面的类圆形囊样透亮区,边界清楚,有薄层硬化边,3例CT及其三维重建显示病灶与关节腔相通。MRI在T1WI呈低信号,T2WI和脂肪抑制T2表现为高信号,MRI显示病灶与关节腔相通2例。结论:骨内腱鞘囊肿影像学表现有一定特征,CT及其三维重建对病灶细节显示清晰,可作为首选检查方法。     

Clinical and radiological features of biliary papillomatosis

Biliary papillomatosis is a rare disease with strong potential for malignant degeneration. Diagnosis is often not easy and most are made intraoperatively. In the present study, five patients with biliary papillomatosis admitted between 1990 and 1997 were reviewed. Their clinical presentation, radiological and biochemical findings were analysed. The aim of the study was to discern a set of characteristic features that would enable an early diagnosis. All of the five patients presented with recurrent episodes of acute cholangitis and epigastric pain with raised serum alkaline phosphatase. Imaging modalities including ultrasound, CT, endoscopic retrograde cholangio-pancreatogram, MRI and magnetic resonance cholangio-pancreatogram were reviewed. Salient imaging features included a dilated biliary tree with multiple ill-defined and fuzzy filling defects or endoluminal frond-like mass lesions. In conclusion, biliary papillomatosis is a rare but important cause of biliary obstruction with relapsing cholangitis and obstructive jaundice. With a healthy index of suspicion, the diagnosis can be reached when the above features are available.     

Variations in radiological features between primary and secondary ovarian malignancies

Objectives

To describe the patient characteristics, imaging features, biomarkers raising the possibility of secondary ovarian tumors. How imaging features of secondary ovarian tumors vary according to the origin of the primary tumor.

Giant cell-rich osteosarcoma in long bones: clinical, radiological and pathological features

Purpose

The purpose of this study was to review the clinical presentation, imaging, pathology and outcome of patients with giant cell-rich osteosarcoma (GCRO) of long bones.

Materials and methods

Radiography (n=9), magnetic resonance imaging (MRI) (n=6), computed tomography (CT) (n=3) and clinical course of nine patients (five males and four females; mean age, 26 years) with pathologically confirmed GCRO were retrospectively reviewed. Specific imaging findings, including size, eccentricity, ossification, lysis, cystic change, expansile growth, periosteal reaction, cortical destruction, soft tissue extension and joint involvement were documented.

Results

Presenting symptoms were pain in six patients and pain and palpable mass in three. An ill-defined margin surrounding a predominantly osteolytic lesion was detected at the proximal tibia (n=7) or femur (n=2) on imaging studies. Seven cases showed limited ossification. Three cases had tumours in the metaphysis and six in the metaepiphysis. The average maximum tumour dimension was 4.7 cm×5.2 cm×7.8 cm. Microscopically, tumours were composed of atypical cells with scanty osteoid formation and multinucleated giant cells. All patients received chemotherapy, and surgery was performed in eight patients. Three patients were dead and six were alive at the last follow-up.

Conclusions

GCRO is a rarer variant that has very close resemblance to giant cell tumour. Patients usually present nonspecific symptoms of pain and palpable mass. It usually shows an osteolytic lesion with locally spared new bone formation in the metaphysis and/or metaepiphysis on imaging. Histologically, the atypical tumour cells with osteoid formation and multinucleated giant cells are the key factor in the diagnosis and differential diagnosis.     

Clinical features and radiological manifestations of COVID-19 disease

Coronavirus disease 2019 (COVID-19) was discovered after unusual cases of severe pneumonia emerged in December 2019 in Wuhan Province (China). Coronavirus is a family of single-stranded RNA viruses. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted from person to person. Although asymptomatic individuals can transmit the virus, symptomatic patients are more contagious. The incubation period ranges from 3-7 d and symptoms are mainly respiratory, including pneumonia or pulmonary embolism in severe cases. Elevated serum levels of interleukins (IL)-2, IL-6, IL-7 indicate the presence of cytokine release syndrome, which is associated with disease severity. The disease has three main phases: Viral infection, pulmonary involvement, and hyperinflammation. To date, no treatment has proved to be safe or effective. Chest X-ray and computed tomography (CT) are the primary imaging tests for diagnosis of SARS-CoV-2 pneumonia, follow-up, and detection of complications. The main radiological findings are ground-glass opacification and areas of consolidation. The long-term clinical course is unknown, although some patients may develop pulmonary fibrosis. Positron emission tomography-computed tomography (PET-CT) is useful to assess pulmonary involvement, to define the affected areas, and to assess treatment response. The pathophysiology and clinical course of COVID-19 infection remain poorly understood. However, patterns detected on CT and PET-CT may help to diagnose and guide treatment. In this mini review, we analyze the clinical manifestations and radiological findings of COVID-19 infection.     

儿童闭塞性毛细支气管炎影像学表现

目的探讨胸部X线片和薄层CT对儿童闭塞性毛细支气管炎（B0）的诊断价值。方法回顾性分析12例经临床诊断证实的BO患儿的资料，其中男9例，女3例，年龄5个月～11岁，所有患儿症状均持续6周以上。12例均行胸部前后位X线片、肺部薄层CT、纤维支气管镜、痰液、支气管肺泡灌洗液和肺功能检查，1例行肺灌注扫描。结果12例均有典型临床特征和肺功能不可逆性小气道阻塞；1例肺灌注扫描示右下肺下段偏外侧放射性缺损低血流灌注表现；9例纤维支气管镜检为支气管内膜炎；4例活检病理提示慢性炎症。胸部X线片表现为：肺透光度增高8例；肺纹理增多，增粗6例；肺实变或不张6例；单侧或局限性透明肺4例。薄层CT表现为：“马赛克”征象，实质密度减低11例，血管细少10例；支气管扩张7例；支气管壁增厚9例；单侧或限局性透明肺4例。实质病变6例；结节征3例；支气管黏液栓5例。结论儿童BO的薄层CT表现比胸部X线片更具有特征性，诊断儿童BO可以基于临床表现、薄层CT和肺功能检查。     

The radiological appearances of telangiectatic osteosarcoma

Fourteen telangiectatic osteosarcomas are reported. They are rare, clinically and radiologically aggressive lesions, involving mainly the femurs of young patients, often misdiagnosed as aneurysmal bone cysts. An explanation for a characteristic early radiological appearance consisting of regular parallel striations of the shaft is suggested.     

Primary and secondary breast lymphoma: prevalence, clinical signs and radiological features

Objectives

The purpose of this study was to determine the prevalence, clinical signs and radiological features of breast lymphoma.

Methods

This is a retrospective review of 36 patients with breast lymphoma (22 primary and 14 secondary). 35 patients were female and 1 was male; their median age was 65 years (range 24–88 years). In all patients, the diagnosis was confirmed histopathologically.

Results

The prevalence of breast lymphoma was 1.6% of all identified cases with non-Hodgkin lymphoma and 0.5% of cases with breast cancer. B-cell lymphoma was found in 94% and T-cell lymphoma in 6%. 96 lesions were identified (2.7 per patient). The mean size was 15.8±8.3 mm. The number of intramammary lesions was higher in secondary than in primary lymphoma. The size of the identified intramammary lesions was larger in primary than in secondary lymphoma. Clinically, 86% of the patients presented with solitary or multiple breast lumps. In 14%, breast involvement was diagnosed incidentally during staging examinations.

Conclusion

On mammography, intramammary masses were the most commonly seen (27 patients, 82%). Architectural distortion occurred in three patients (9%). In three patients (9%), no abnormalities were found on mammography. On ultrasound, the identified lesions were homogeneously hypoechoic or heterogeneously mixed hypo- to hyperechoic. On MRI, the morphology of the lesions was variable. After intravenous administration of contrast medium, a marked inhomogeneous contrast enhancement was seen in most cases. On CT, most lesions presented as circumscribed round or oval masses with moderate or high enhancement.Ductal and lobular carcinomas are the most frequent tumours of the breast. Breast involvement by lymphoma is very rare. It can occur as a primary breast tumour or as an extranodal manifestation in systemic disease [1-5]. According to the literature, the prevalence of breast lymphoma (BL) ranges from 0.04 to 0.5% of malignant breast neoplasms [1,2]. In addition, the prevalence of primary BL (PBL) varies from 0.85 to 2.2% of extranodal malignant lymphomas [3-5]. Secondary BL (SBL) is more common [6-8]. The rarity of BL can be attributed to the fact that the breast contains very little lymphoid tissue [9,10].Only a few of the published studies focus on the radiological features of BL, and conflicting findings of BL have been reported [1,7,11-13]. Only in one investigation has the distinction between primary and secondary breast involvement been taken into consideration [1]. Therefore, the aim of this study was to determine the prevalence of BL in our population and to analyse its clinical and radiological characteristics.