骨原发血管性恶性肿瘤6 例影像学特征分析

目的 探讨骨原发血管性恶性肿瘤的影像征象，以提高本病的影像诊断水平。方法 收集2017年5月至2022年2月6例病理证实的骨原发血管性恶性肿瘤术前临床及影像资料，其中上皮样血管内皮瘤2例，血管肉瘤4例。6例均进行了X线、CT平扫和MRI检查，其中1例行CT增强检查，2例行MRI增强扫描。分析X线、CT及MRI影像特点。结果 上皮样血管内皮瘤1例为单发病灶，1例为多发病灶，X线均表现为溶骨性骨质破坏。4例血管肉瘤中，位于骨盆者1例，单发位于长骨者2例，下肢骨广泛破坏者1例，X线为溶骨性骨质破坏，部分有硬化边。CT表现为溶骨性骨质破坏伴软组织肿块形成，髂骨病灶见硬化边，病灶内见高密度钙化影，6例病灶均无骨膜反应。磁共振T1加权像（T1 weighted image，T1WI） 肿块信号比肌肉高，磁共振T2加权像（T2 weighted image，T2WI）信号混杂，整体较高，磁共振T2压脂序列（fat suppreion-T2WI，T2-fs ）呈高信号，大部分病灶周围无水肿，增强扫描明显强化。结论 骨原发血管性恶性肿瘤影像表现多样化，多发、T2信号较高、无骨膜反应，MRI增强扫描明显强化有助诊断。

Analysis of imaging features of primary vascular malignant tumor of bone in 6 cases

Objective To study the imaging features of primary vascular malignant tumor of bone in order to improve its preoperative imaging diagnosis. Methods Clinical and imaging data of 6 cases of primary vascular malignant tumor of bone, which were confirmed by surgical pathology from May 2017 to February 2022, were retrospectively reviewed. There were 2 cases of epithelioid hemangioendothelioma and 4 cases of hemangiosarcoma. All 6 patients underwent X-ray, CT plain scan and MRI examination. In addition, 1 patient had CT enhancement examination and 2 had MRI enhancement scan. Results One case of the epithelioid hemangioendothelioma was a single lesion located in the second cervical vertebra. The other was a multiple lesion in the left hand with a soft tissue mass under the skin. Among the 4 cases of hemangiosarcoma, 1 case was located in the pelvis, 2 cases in the long bone as an isolated lesion, and 1 case in the lower limb with extensive bone destruction. X-ray showed osteolytic destruction, with some sclerotic edges. CT showed osteolytic destruction with soft tissue mass formation. Iliac crest lesions showed sclerotic edges and high-density calcification shadows. None of the 6 lesions had periosteal reaction. On T1 weighted image (T1WI), the mass signal was higher than the muscle signal. The T2 weighted image (T2WI) signal was mixed and overall high. On fat suppreion-T2WI(T2-fs), the area of edema around the lesion was small. Enhancement scan showed significant enhancement. Conclusion Primary vascular malignant tumors of bone are varied radiographically. Multiple lesion, high T2WI signal, no periosteal reaction and obvious enhancement are helpful for the diagnosis.