长骨骨巨细胞瘤的影像诊断

目的比较X线、CT、MRI对骨巨细胞瘤的诊断特点及其鉴别诊断,以提高对骨巨细胞瘤的影像诊断能力。方法对23例经手术和病理证实的长骨骨巨细胞瘤的X线、CT、MRI表现进行影像对照、对比分析。结果长骨骨巨细胞瘤多发生在股骨下端和胫骨上端,X线表现为长管状骨骨端偏心性、膨胀性骨质破坏,骨壳多薄而完整,其间可见骨间隔,典型者构成皂泡样改变。CT扫描显示大多数骨壳并不完整,肿瘤内看不到真正的骨间隔。溶骨性巨细胞瘤呈溶骨性改变,多无完整的骨壳和骨间隔,肿瘤的边缘残留的骨壳仍保留膨胀的特征,并可看到和骨壳缺损区相一致的软组织肿块。CT还能清楚地显示肿瘤内有无出血、破坏、钙化等内部结构。肿瘤呈膨胀性破坏,T1WI呈均匀中等或低信号强度,T2WI呈混杂信号,有些区域呈高信号,为液化、坏死或出血。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,结合CT、MRI可提高骨巨细胞瘤的诊断和鉴别诊断能力。

Imaging diagnosis of giant cell tumor of long tubular bone

Objective To compare the diagnostic characteristics of X-ray,CT,and MRI in giant cell tumor of long tubular bone,and to improve the capability of imaging diagnosis of this tumor.Methods The appearances of X-ray,CT,MR were compared and analyzed in twenty-three cases with giant cell tumor of long tubular bone proved by pathology.Results Most of giant cell tumor located in distal femur and proximal tibia with expansive growth and thin and full bony shell,the bone separtation was visible,the soap bubbles could be found in typical cases.Most of bony shell of tumor were half-baked without bone separtation.The dissolve osseous of bone were found in dissolve osseous bone giant cell tumors without full bony shell and bone separtation,the soft tissue mass and expansile changes were remained in the edge of tumors.Bleeding,destruction,calcification also could be clearly found inside of tumor by CT.On MRI,the giant cell tumors were expansile destruction,and presented intermediate or low signal on T1WI and miscellaneous signals on T2WI,liquefied necrotic and bleeding were presented high signals.Conclusion Most of the giant cell tumors have typical X-ray appearance,it is not difficult to make correct diagnosis,the capability of indentification and diagnosis may be improved by CT combined with MR.