长骨中心型Ⅰ级软骨肉瘤与内生软骨瘤的影像鉴别诊断  

Imaging differentiation of central grade I chondrosarcoma from enchondroma in long bones

作　　者：周建功[1] 袁小东[2] 马小龙[3] 袁渊[3] 胡友[3] 张雪凤[3] 杨盼盼[3] 王铁功[3] 

机构地区：[1]河南科技大学第二附属医院放射科,洛阳471002 [2]解放军第309医院放射科 [3]第二军医大学附属长海医院影像医学科,上海200433

出　　处：《中华放射学杂志》2014年第11期926-929,共4页Chinese Journal of Radiology

基　　金：长海医院“1255计划”学科特色提升项目（CH125520804）

摘　　要：目的 探讨长骨中心型Ⅰ级软骨肉瘤和长骨内生软骨瘤的影像鉴别诊断特征.方法 回顾性分析经手术病理及术后5年随访证实的18例长骨中心型Ⅰ级软骨肉瘤和14例长骨内生软骨瘤患者资料,患者均行患肢X线片、MR平扫及增强扫描.观察2组患者的影像表现,并采用x2检验比较各影像征象的出现率.结果 （1）X线表现：中心型Ⅰ级软骨肉瘤和内生软骨瘤均表现为骨髓腔内中心性分布的多发斑片状、簇状骨化,病变周围无硬化边,病灶内及周边无溶骨样破坏,病灶无明显边界,肿瘤范围难以评估.（2）MR表现：2种疾病的所有患者均无肿瘤内出血,但均出现肿瘤内骨化和肿瘤周边花环样强化.18例中心型Ⅰ级软骨肉瘤中,16例病变累及骨端及干骺端,15例侵犯骨皮质,13侧周边骨髓出现异常信号.14例内生软骨瘤中,8例病变累及骨端及干骺端,1例侵犯骨皮质,4例周边骨髓出现异常信号.2种疾病患者以上征象差异有统计学意义（x2值分别为4.233、18.286和6.026,P均＜0.05）.软组织肿块仅见于2例中心型Ⅰ级软骨肉瘤中.结论 MR图像上的病变接近骨端、侵犯骨皮质、周边骨髓出现异常信号和软组织肿块征象,有助于鉴别长骨中心型Ⅰ级软骨肉瘤和长骨内生软骨瘤.Objective To evaluate imaging features for in differentiating central grade Ⅰ chondrosarcoma from enchondroma in long bones.Methods Images of 32 patients with central grade Ⅰ chondrosarcoma （n=18） and enchondroma in long bones （n=14） confirmed by surgery and postoperative 5 years follow up were retrospectively reviewed.All patients underwent X-ray,enhanced and non-enhanced MRI.Imaging features were independently assessed.The Chi-square test was used to identify features with differentiating strength Results （1） X-ray：all tumors documented multiple patchy and cluster ossifications located in the central regions of marrow cavities,and there was no sclerified edges around the tumors.Osteolysis were not seen within or around the lesions.It was difficult to estimate the extent of tumors because there was no definite boundary.（2） MR：there was no hemorrhage,ossification and margin enhancement seen in all cases.Of the 18 central grade Ⅰ chondrosarcomas,16 was located in diaphysis/metaphysis of the extremities,15 had cortical bony destruction,13 had abnormal signal around bone marrow.Of the 14 enchondroma in long bone,8 was located in diaphysis/metaphysis of the extremities,1 had cortical bony destruction,4 had abnormal signal around bone marrow.No statistically significant difference was found between central grade [chondrosarcoma and enchondroma in long bones.（x2 values were 4.233,18.286,6.026,P〈0.05）.Soft masses were only seen in central grade Ⅰ chondrosarcomas.Conclusion Location in diaphysis/metaphysis of the extremities,cortical destruction,soft mass,and abnormal signal around marrow are the most reliable predictors for differentiating central grade Ⅰ chondrosarcoma from enchondroma in long bones.

关 键 词：骨肿瘤 磁共振成像 骨软骨瘤 软骨肉瘤 

分 类 号：R738.3[医药卫生—肿瘤]