距骨肿瘤及瘤样病变的影像学特点  

Imaging diagnosis of bone tumor and tumor-like lesion in the talus

作　　者：潘涛[1] 王林森[1] 胡永成[2] 王淑丽[1] 万业达[1] 

机构地区：[1]天津医科大学天津医院放射科,300211 [2]天津医科大学天津医院骨肿瘤科,300211

出　　处：《中华骨科杂志》2014年第11期1151-1160,共10页Chinese Journal of Orthopaedics

基　　金：基金项目：天津市自然科学基金（12jCYBJC16400）;天津市卫生局科技基金（12KG121,2011KY24）

摘　　要：目的分析距骨肿瘤及瘤样病变的病种分布及其影像学表现。方法对2002年3月至2013年9月经手术及病理证实的33例距骨肿瘤及瘤样病变的影像学表现进行回顾性分析，男24例，女9例。所有病例均行X线检查，23例行CT检查，11例行MR检查。结果33例距骨病变中成软骨细胞瘤7例（21．2％），骨巨细胞瘤7例（21．2％，其中1例为术后复发病例），骨软骨瘤6例（18．2％），骨样骨瘤2例（6．1％），邻关节囊肿7例（21．2％），骨纤维结构不良2例（6．1％），骨囊肿1例（3％），骨恶性纤维组织细胞瘤1例（3％）。合并病理性骨折6例。成软骨细胞瘤、骨巨细胞瘤、邻关节囊肿、骨纤维结构不良、骨囊肿等良性肿瘤及瘤样病变的X线、CT表现为囊性骨破坏。成软骨细胞瘤好发于距骨体后部（57％），轻度膨胀，边缘轻度硬化。骨巨细胞瘤边缘呈不规则硬化，可见骨嵴。MRI依病灶组成可有不同表现，通常为T1WI呈等、低信号，T2WI呈高信号。骨软骨瘤表现为与距骨相连的骨性突起，可见软骨帽钙化。距骨恶性纤维组织细胞瘤的X线、CT均呈溶骨性破坏，可见软组织肿块，无骨膜反应及肿瘤骨；MRIT1WI呈等、低信号，T2WI呈等、高信号，肿瘤侵犯范围显示清晰。结论距骨肿瘤及瘤样病变少见且病种较多，良性多于恶性。成软骨细胞瘤、骨巨细胞瘤、骨软骨瘤、骨样骨瘤、邻关节囊肿相对好发，影像学表现有一定的特征。恶性肿瘤虽少，但仍有发生的可能。Objective To research the variety and the imaging features of bone tumor and tumor-like lesions in the talus. Methods The imaging features of 33 cases of tumor and tumor-like lesions in the talus were reviewed retrospectively. All cases were confirmed by operation and pathology, All of 33 cases were performed X-ray examination, 23 cases were examined by CT, and 11 cases were taken by MR. Results In 33 cases, 24 cases were males, 9 cases were females; including 7 cases of chondro- blastoma（21.2%）, 7 cases of giant cell tumor（21.2%）（1 case of recurrence）, 6 cases of osteochondroma（18.2%）, 2 cases of osteoid osteoma（6.1%）, 7 cases of adjacent joint bone cyst（21.2%, 2 cases of fibrous dysplasia of bone（6.1%）, 1 case of bone cyst（3%）, 1 case of malignant fibrous histiocytoma（MFH） of bone（3%）. 6 cases showed pathological fractures. The X-ray and CT imaging fea- tures of chondroblastoma, giant cell tumor, adjacent joint bone cyst, fibrous dysplasia of bone, bone cyst demonstrated cystic bony destruction. The common location of chondroblastoma were the posterior of talus（57%）, expanding growth slightly, margin were mild osteosclerosis.The margin were osteosclerosis irregularly and osteal ridges showed in giant cell tumor. MRI features were dif- ferent on pathologic basis, isointense and hypointense signal on T1WI and hyperintense signal on T2WI usually. The osteochondro- ma showed osseous protuberance connecting the talus, some cases showed calcification in the cap. The imaging of MFH in the talus X-ray and CT showed ill-defined osteolytic bony destruction, soft tissue-mass, no periosteal reactions and bone formation. MRI showed isointense and hypointense signal on TIWI and isointense and hyperintense signal on T2WI. The extent of tumour invasion clearly displayed. Conclusion Tumor and tumor- like lesion in the talus were rare. But there are great varieties. The benign tumor was more common than malignant tumor. Chondroblastoma, giant cell tumor, osteochondroma, osteoid osteoma a

关 键 词：距骨 骨肿瘤 放射摄影术 体层摄影扫描仪 X线计算机 磁共振成像 

分 类 号：R738.1[医药卫生—肿瘤]