X线平片、CT和MRI在原发骨肉瘤诊断中的价值

目的分析原发骨肉瘤的X线平片、CT和MRI表现,探讨三者在原发骨肉瘤诊断中的价值。方法搜集16例经手术病理证实的原发骨肉瘤病例。男性患者11例,女性5例。患者年龄在15～48岁,平均26岁。其中发生在股骨的原发骨肉瘤8例,胫骨5例,肱骨3例。回顾性分析其X线平片、CT和MRI表现。结果 16例均经X线平片、CT和MRI检查,X线平片检查诊断正确率为88%,CT检查正确率为100%,MRI检查正确率为100%。16例原发骨肉瘤中成骨型骨肉瘤3例,溶骨型骨肉瘤2例,混合型骨肉瘤11例。X线平片对骨质破坏、骨膜反应、软组织肿块、瘤骨和Cod-man三角检出率分别为88%、63%、56%、56%、44%;CT对骨质破坏、骨膜反应、软组织肿块、瘤骨和Codman三角检出率分别为100%、75%、94%、75%、25%;MRI对骨质破坏、骨膜反应、瘤骨、软组织肿块、瘤周水肿区及Codman三角检出率为100%、25%、25%、100%、100%、19%。CT对骨质破坏、骨膜反应、软组织肿块、瘤骨的显示敏感,对Codman三角的显示不如X线平片;MRI对骨膜反应、瘤骨的显示不如X线平片和CT;X线平片和CT不如MRI对骨质破坏、软组织肿块及瘤周水肿的显示。结论 X线平片是诊断骨肉瘤的首选检查方法,CT、MRI可以提供更丰富的诊断信息,MRI为外科选择治疗方式提供可靠依据。

Value of Radiography,CT and MRI in Diagnosis of Primary Osteosarcoma

Objective To analyze the radiography,CT and MRI manifestations of primary osteosarcoma and to discuss the value of them in the diagnosis of primary osteosarcoma.Methods To collect 16 cases of primary osteosarcoma which were confirmed by pathological examination.There were 11 males and 5 females,with the age ranged from 15 to 28 years（mean 22 years）.The lesions affected femur（n=8）,tibia（n=5）,humerus（n=3）.The imaging findings of radiography,CT and MRI were retrospectively analyzed.Results Sixteen patients were all examined by radiography,CT and MRI.The exact rate of radiography,CT and MRI scan was 88%,100% and 100%,respectively.In 16 cases,the osteoblastic pattern sarcoma was found in 3 cases,osteolytic pattern sarcoma in 2 cases and mixed pattern sarcoma in 11 cases.The detection rates of bone destruction,periosteal reaction,soft-tissue mass,neoplastic bone and Codman triangle by radiography were 88%,63%,56%,56% and 44%,respectively;by CT were 100%,75%,94%,75% and 25%,respectively.The detection rates of bone destruction,periosteal reaction,neoplastic bone,soft-tissue mass,presented hydropsia around the lesions and Codman triangle by MRI were 100%,25%,25%,100%,100% and 19%,respectively.Bone destruction,periosteal reaction,soft-tissue mass,neoplastic bone were showed sensitively by CT,but Codman triangle was more sensitive showed by radiography.Periosteal reaction and neoplastic bone were showed sensitively by radiography and CT,which was superior to MRI.Bone destruction,soft-tissue mass and presented hydropsia around the lesions was showed sensitively by MRI,which was superior to radiography and CT.Conclusion Radiography is the first choice for diagnosing primary osteosarcoma.CT and MRI can provide more information than radiography.MRI can provide information for surgery planning.