MRI对四肢长骨高低级别软骨肉瘤的鉴别价值  

MRI for differentiating high-grade from low-grade of limb long bone chondrosarcoma

作　　者：邓晓娟[1] 张伟国[1] 方靖琴[1] 罗清雅[2] 陈金华[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所放射科,重庆400042 [2]第三军医大学大坪医院野战外科研究所病理科,重庆400042

出　　处：《重庆医学》2015年第26期3637-3640,共4页Chongqing medicine

基　　金：重庆市研究生教育教学改革研究重点项目(Yjg110227)

摘　　要：目的探讨四肢长骨高级别与低级别软骨肉瘤的影像学鉴别。方法回顾分析经手术及病理证实的四肢长骨软骨肉瘤23例,其中低级别13例,高级别10例。对二者的磁共振影像学特征,包括骨皮质扇贝样改变,骨皮质增厚,骨皮质破坏,骨膨胀性改变,软组织肿块,骨髓水肿,软组织水肿,钙化,出血,肿块最大径线及增强特征分别进行统计学分析。结果低级别软骨肉瘤13例,包括非典型软骨样肿瘤及软骨肉瘤Ⅰ级;高级别软骨肉瘤10例(Ⅱ级8例,Ⅲ级1例,去分化型1例)。骨皮质破坏,软组织肿块及软组织水肿在高低级别之间差异有统计学意义,骨髓水肿有显著统计学差异。钙化+在高低级别之间有显著统计学差异,++有统计学差异。低级别软骨肉瘤肿块最大径线的直径约(6.2±2.9)cm,高级别直径约(9.3±5.2)cm,二者之间差异有统计学意义。明显斑片状/筛网状强化在高低级别软骨肉瘤之间差异有统计学意义。结论软骨肉瘤影像学特征中,骨皮质破坏、软组织肿块、软组织水肿、骨髓水肿、钙化比例、肿瘤最大径线及强化方式对鉴别四肢长骨低级别与高级别软骨肉瘤有一定价值。Objective To investigate the imaging differentiation between high-grade and low-grade limb of long bone chondrosarcoma.Methods The MRI imaging features in 23 cases of pathologically proven limb long bone chondrosarcomas were retrospectively analyzed,including 13 cases of low-grade and 10 cases of high-grade.The MRI imaging features including endosteal scalloping lesion,cortical thickening,cortical destruction,bone expansion,soft tissue mass,bone marrow edema,soft tissue edema,calcification,hemorrhage,tumour maximal radial line and enhancing features were performed the statistical analysis.Results 13 cases were the low-grade chondrosarcomas,including atypical cartilaginous tumour and grade 1chondrosarcomas,10 cases were highgrade chondrosarcomas（8cases of grade Ⅱ chondrosarcomas,1case of gradeⅢ chondrosarcomas and 1case of dedifferentiated chondrosarcomas）.Cortical destruction,soft tissue mass and soft tissue oedema had statistical differences between the low-grade and high-grade.Bone marrow had statistically significant difference.Calcification＋（SC〈1/3ST）had statistical difference between the low-grade and the high-grade.Calcification ＋＋（1/3ST〈SC〈2/3ST）had statistical difference.The diameter of maximal radial line in the low-grade chondrosarcomas was（6.2 ±2.9）cm and which in the high-grade was（9.3±5.2）cm,showing statistical difference between them.The speckling and sieving enhancement had statistical differences between the low-grade and highgrade chondrosarcomas.Conclusion In the MRI imaging features of chondrosarcoma,cortical destruction,soft tissue mass,bone marrow edema,soft tissue edema,bone marrow edema,calcification proportion,tumor maximal radial line and enhancing features can be valuable to differentiate low-grade from high-grade limb long bone chondrosarcoma.

关 键 词：低级别软骨肉瘤 高级别软骨肉瘤 长骨 磁共振成像 

分 类 号：R738.1[医药卫生—肿瘤]