骨孤立性浆细胞瘤的影像诊断  

Imaging diagnosis of solitary plasmacytoma in bone

作　　者：苗焕民[1] 

机构地区：[1]苏州大学附属第一医院放射科,江苏苏州215006

出　　处：《实用放射学杂志》2018年第1期75-77,81,共4页Journal of Practical Radiology

摘　　要：目的 收集不同部位的骨孤立性浆细胞瘤（SPB）进行影像学分析,总结其影像学特点.方法 回顾性分析本院经临床病理证实的22例SPB的影像学特点,其中DR 15例,CT 20例,MRI平扫及增强11例,同时进行DR、CT、MRI检查者8例.结果 22 例SPB 分别位于脊柱（n=9） ？肱骨（n=1） ？肩胛骨（n=2） ？胸骨（n=1） ？髂骨（n=3） ？耻骨（n=1） ？肋骨（n=2） ？额骨（n=1） ？下颌骨（n=2） .DR 及CT 表现为病灶区膨胀性生长,并可见穿凿样溶骨性骨质破坏,病灶边界清晰,呈现＂破而不烂＂的影像学特征,部分可见周围软组织肿块（n=7）或骨嵴（n=11） ,所有病例均未见明显骨膜反应;其中1 例发生于下颌骨者表现为局限性密度增高,被误诊为牙瘤.与肌肉信号相比,MRI 表现为T1 WI 等或稍高信号？T2 WI 高信号,DWI 均表现为高信号,均未见明显瘤周水肿,但可见不同程度软组织浸润,有残存骨嵴者,可见＂微脑征＂ ,发生于脊柱者有4 例病变椎体周围可见软组织肿块,表现为＂袖套征＂ ;增强扫描后肿瘤明显强化.结论 SPB 诊断相对较难,需结合影像？临床及实验室检查等综合判断.Objective To investigate the imaging findings of solitary plasmacytoma in bone（SPB）to improve the diagnostic accuracy. Methods The imaging data of 22 cases with SPB confirmed by pathology were reviewed retrospectively,including DR（n=15）,CT （n=20）and MRI（n=11）.8 patients were examined by DR,CT and MRI.Results The tumors were located at vertebrae（n=9）,humerus （n=1）,scapula（n=2）,sternum（n=1）,ilium（n=3）,pubis（n=1）,ribs（n=2）,frontal bone（n=1）and mandible（n=2）.The lesions showed as expansive growth and punched-out like bone destruction with well-defined margins on DR and CT.Soft tissue masses（n=7） or bony ridge（n=11）could be observed.No periosteal reaction was shown in any cases.One case was misdiagnosed as odontoma, which demonstrated as patchy high-density lesion in the mandible.The lesions were of same signal or slightly hyper-intensity on T1WI and hyper-intensity on T2WI and DWI compared with the muscle signal.There was soft tissue infiltration without obvious peritumoral edema.The lesions combined with bony ridge were shown as＂mini brain＂sign.＂Cuff sign＂could be seen in 4 cases in the vertebrae. The tumors enhancement was obvious after injection of contrast agent.Conclusion The diagnosis of SPB is relatively difficult,and should be comprehensively analyzed by combining imaging features,clinical and laboratory examinations.

关 键 词：骨 孤立性浆细胞瘤 计算机体层成像 磁共振成像 

分 类 号：R738.1[医药卫生—肿瘤] R814.42[医药卫生—临床医学]