髓内高分化骨肉瘤的影像学诊断

目的:探讨髓内高分化骨肉瘤的影像表现及其诊断价值.方法:分析经穿刺或手术病理证实的22例髓内高分化骨肉瘤的X线、CT及MR影像资料特点.其中,19例行X线平片检查,14例行CT检查,19例行MR检查(增强16例).结果:男13例,女9例,平均年龄40.1岁.11例位于股骨骨端,8例位于胫骨骨端,1例位于肱骨近端,1例位于桡骨中段,1例位于腓骨上段;其中,1例转移至肩胛骨关节盂,1例转移至肱骨近端、肩峰及胸椎.X线示混合型骨破坏19例,伴有局部骨皮质突破17例；9例见软组织肿块；5例伴骨膜反应.14例CT扫描中,边界不清的混合型骨破坏13例,1例病灶周缘有明显硬化边.19例MR扫描中,病灶呈T1WI等低、T2WI STIR等高信号,强化明显,其中9例见到骨外软组织肿块形成,其余均见到程度不等的软组织肿胀表现.结论:髓内高分化骨肉瘤以长骨骨端边界不清的混合型骨破坏、瘤骨形成量多少不一为典型表现,有助于诊断与鉴别诊断.

Imaging Diagnosis of Well-differentiated Intramedullary Osteosarcoma

Purpose: To investigate the imaging features of well-differentiated intramedullary osteosarcoma and to evaluate the diagnostic value of them.Methods: Clinical data and imaging findings of 22 cases confirmed by pathology were reviewed.Of 22 cases,19 cases were undergone conventional X-ray exam,14 cases were scanned by CT,and 19 cases were scanned by MR(16 of them were also scanned by post-contrasted MR).Results: These 22 cases(13 males,9 females) had an average age of 40.1 years old.The tumor involved the femoral extremities in 11 cases,the tibia extremities in 8,the proximal humerus in 1,the middle radius in 1,the proximal fibula in 1.One case of them metastasized to the glenoid cavity of scapula,and 1 to the proximal humerus,shoulder peak and the thoracic vertebra.On conventional X-ray films,mixture of sclerosis and lysis was shown in 19 cases;permeative osteolysis of cortical bone in 17 cases;soft tissue mass in 9 cases,periosteal reaction in 5 cases.CT scanning showed the mixture of sclerosis and lysis with poor margination in 13 cases,with marked sclerosis edge around the destruction area in 1 case.MRI showed the lesions were with low to intermediate signal intensity on T1-weighted images and intermediate to high signal intensity on T2-weighted images in all the cases,and were with significant enhancement of the tumor.Extraosseous extension was seen in 9 of 19 cases.Conclusion: Imaging characteristic of well-differentiated intramedullary osteosarcoma is mixture of sclerosis and lysis with poor margination located in the extremities of long bones.Besides,the varying amount of the new bone produced by the tumor is another key point.