原发性骨干骨肉瘤的影像学表现  

The imaging features of primary diaphysial osteosarcoma

作　　者：姚健[1] 孙鼎元[1] 王林森[1] 

机构地区：[1]天津医院放射科,300211

出　　处：《中华骨科杂志》2000年第1期40-43,共4页Chinese Journal of Orthopaedics

摘　　要：目的 总结原发性骨干骨肉瘤的影像学表现, 探讨有关的临床特点和鉴别诊断。方法1980 ～1998 年14 例原发性骨干骨肉瘤患者,均经手术与病理证实。男6 例,女8 例,平均年龄23-5 岁。其中股骨干9 例,腓骨干2 例,肱骨干2 例,胫骨干1 例。回顾性分析14 例原发性骨干骨肉瘤的X 线、CT 和MRI 的表现及相对应的病理学表现。结果 原发性骨干骨肉瘤影像学表现包括广泛骨质破坏、骨膜反应、软组织肿块,部分病例可见肿瘤骨和瘤样钙化。病理证实影像学确定病变范围不准确。同时原发性骨干骨肉瘤具有发病年龄大、病变范围广泛的临床特点。X 线的诊断最佳,CT 检查和MRI 有助于鉴别诊断。结论 原发性骨干骨肉瘤是一种特殊部位的骨肉瘤,发病率低,骨破坏范围大,无病理性骨折。成骨型骨干骨肉瘤较易诊断,溶骨型应与Ewing 瘤。Objective To summarize the imaging manifestations of the primary diaphysial osteosarcoma, and discuss its clinical features and differential diagnosis Methods From 1980 to 1998, fourteen cases of osteosarcoma proved by surgery and pathology were reviewed; there are six males and eight females, with an average age of 23 5 years The pathological types of these lesions were classic in 6, telangiectatic in 2, small cell in 1, parosteal in 1, and osteoblastic in 2 Nine tumors were located in the femur, two fibula, two humerus and one tibia All of the patients had roentgenography, five were evaluated by computer tomography, and one had MRI examination The imaging manifestations including X ray,CT scan and MRI were analyzed, and the relationship of the imaging features with the pathological types of primary diaphysial osteosarcoma was also observed Results The imaging features of primary diaphysial osteosarcoma were composed of large bone destruction, periosteal reaction and soft tissue mass The typical clinical characters consisted of large lesions, with the patients usually over the second decade of life By roentgenographic examination, the parosteal and classic osteosarcoma manifested with osteogenic destruction, the telangiectatic osteosarcoma osteolytic lesion, while the small cell and osteoblastic type manifested with mixed destruction of osteolytic and osteogenic focus Periosteal reaction was found in 11 of 14 patients Tumor calcification was demonstrated more clearly on CT scan than that in the roentgenogram, particularly for osteogenic lesion MRI is helpful to diagnose the involvement of soft tissue and nervovascular bundle by the tumor Conclusion Primary diaphysial osteosarcoma is a special clinical type of osteosarcoma It has lower incidence, large bone destruction and no pathological fracture The osteogenic type is diagnosed easily, but the osteolytic lesion should be differentiated from Ewings sarcoma, malignant giant cell tumor of bone and so on

关 键 词：骨肉瘤 骨干骨肉瘤 影像学诊断 

分 类 号：R738.1[医药卫生—肿瘤]