骨孤立性浆细胞瘤的影像学表现

目的分析不同部位骨孤立性浆细胞瘤的X线、CT和MRI表现，进一步认识与提高骨孤立性浆细胞瘤的诊断准确率。方法回顾性分析12例经临床病理证实的发生于椎体、肱骨、肋骨的孤立性浆细胞瘤病例，总结分析其影像学表现。结果12例孤立性浆细胞瘤为肋骨3例、胸椎6例、肱骨3例，其中1例肱骨发生病理性骨折。X线及CT表现为穿凿样溶骨性骨质破坏、膨胀性生长，边界较清，其中1例骨皮质增厚、硬化，所有均未见明显骨膜反应。与肌肉信号相比，MRI在T1WI表现为稍低信号，T2WI表现为高信号，所有均未见瘤周水肿，但可见不同程度的软组织浸润，5例可见软组织肿块形成，增强明显强化。结论X线平片对骨孤立性浆细胞瘤的诊断敏感度较低；CT能清晰显示瘤体内增厚的骨嵴或残存的骨质；MRI可明确髓腔内外病变与周围软组织的关系。平片、CT和MRI三者联合综合评价有助于提高骨孤立性浆细胞瘤的诊断准确性。

Imaging Features of Solitary Plasmacytoma of Bones

ObjectiveTo improve diagnostic ability by analyzing the imaging features of X-ray, CT and MRI for solitary plasmacytoma occurred in different sites of bones.MethodsWe retrospectively reviewed twelve pathologically proven cases of solitary plasmacytoma that existed on centrums, shoulder bones and ribs, and summarized their imaging features.ResultsThe prevalence bones were the rib (n=3), thoracic vertebra (n=6), and the shoulder bone (n=3). Of those, pathological fracture had one case on shoulder bone. X-ray and CT showed osteolytic destruction and expansive growth with relative clear border. Periosteal reaction was not observed inall cases, although one case had cortical bone thickening, hardening.Solitary plasmacytoma showed homogeneous slight hypo-intensity on T1-weighted MR images and hyper-intensity on T2-weighted MR images compared to muscle. Peritumoral edema was not observed in all the cases, but soft-tissueinvasion in various degree was clear and soft-tissue mass was apparent in five cases with enhanced contrast.ConclusionX-ray was lower sensitive for solitary plasmacytoma in bones; CT could clearly show the thickening trabecula and residual bone in the tumor; MRI could show the relationship between exterior and interior pathological of medullary cavity and surrounding soft tissue. Combination of radiography, CT and MR imaging might improve diagnosis.