软骨肉瘤的影像诊断与鉴别诊断  

Imaging features of chondrosarcoma

作　　者：袁明智[1] 黄永[2] 任瑞美[3] 

机构地区：[1]临沂市人民医院影像科,山东276001 [2]山东省肿瘤医院放射科,济南250017 [3]山东省肿瘤医院放疗科,济南250017

出　　处：《放射学实践》2012年第8期893-897,共5页Radiologic Practice

摘　　要：目的:探讨软骨肉瘤的影像学表现,提高对本病诊断的准确性。方法:回顾性分析25例经手术病理证实的软骨肉瘤的X线、CT和MRI资料。结果:25例软骨肉瘤中原发23例,其中普通型20例,去分化型、黏液型及透明细胞型各1例;继发2例。X线及CT表现:原发的23例中溶骨性骨破坏5例,混合性骨破坏18例,形成软组织肿块20例,其中表现为低密度19例,等密度1例。20例普通型及1例黏液型见散在钙化。MRI表现:普通型软骨肉瘤T1WI呈等或稍低信号,T2WI呈等或稍高信号;黏液型T1WI呈等、低混杂信号,T2WI呈稍高、低的混杂信号,钙化T2WI呈低信号;透明细胞型病例T1WI及T2WI呈近乎等信号;去分化型T1WI呈等低混杂信号,T2WI呈不均匀高信号。6例普通型及1例继发型出现环形、间隔样中等-明显强化,黏液型及去分化型呈不均匀中等-明显强化。结论:普通X线及CT是软骨肉瘤影像诊断及鉴别诊断的主要手段,MRI显示软骨信号为重要提示。MRI显示病变范围更为清楚、准确,为临床治疗提供可靠依据。Objective：To describe and analyze imaging appearances of chondrosarcoma,including radiographic,CT and MR imaging features. Methods： We retrospectively reviewed twenty five pathologically proven cases of chondrosarcoma. Results： Of the 25 cases with chondrosarcoma,23 were primary chondrosarcoma consisting of conventional chondrosarcoma （n= 20）, dedifferentiated chondrosarcoma （n= 1）, myxoid chondrosarcoma （n=1 ） and clear cell chondrosarcoma （n=1 ）. On X-ray and CT imaging,of the 23 cases with primary chondrosarcoma, 5 had lytic bone destruction and the others had mixed lytic and sclerotic bone destruction,20 had soft tissue masses which presented as low density （n=19） or iso-density （n= 1）. Sporadic calcification was present in 20 cases of conventional chondrosarcoma and 1 case of myxoid chondrosarco- ma. Conventional chondrosarcoma showed isointensity or hypointensity compared to muscle on T1 weighted MR images and isointensity or hyperintensity on T1-weighted MR images. Myxoid chondrosarcoma showed heterogeneous isointensity and hypointensity to muscle on T1-weighted MR images and heterogeneous hyperintensity on T2-weighted MR images. Calcifi- cation was presented as hypointensity to muscle on T2WI. Clear cell chondrosarcoma showed isointensity signal both on T1 WI and T2WI. Dedifferentiated chondrosarcoma showed isointensity and hypointensity on T1 WI, and heterogeneous hy perintensity on T2WI. 6 cases of conventional and 1 case of secondary chondrosarcoma showed peripheral and septal en- hancement, 1 case of dedifferentiated chondrosarcoma and 1 case of myxoid chondrosarcoma showed heterogeneous enhance- ment. Concluslon： Radiography or CT is the first-line imaging test of choice for the diagnosis of chondrosarcoma. MRI pro- vides more accurate information for clinical therapy of chondrosarcoma in terms of morphologic features.

关 键 词：软骨肉瘤 体层摄影术 X线计算机 磁共振成像 

分 类 号：R738.1[医药卫生—肿瘤]