骨原发性平滑肌肉瘤的影像表现  

Primary leiomyosarcoma of bone:imaging findings

作　　者：徐丹君 王加伟[1] 徐雷鸣[1] Xu Danjun;Wang Jiawei;Xu Leiming(Department of Radiology,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Radiology,Xiangshan First People′s Hospital,Ningbo 315700,China)

机构地区：[1]浙江大学医学院附属第二医院放射科,杭州310009 [2]浙江省宁波市象山县第一人民医院放射科,315700

出　　处：《中华放射学杂志》2019年第8期685-689,共5页Chinese Journal of Radiology

摘　　要：目的探讨骨原发性平滑肌肉瘤(PLB)的X线平片、CT、MRI、SPECT骨显像检查的影像特点,提高影像诊断水平。方法由2名高年资骨肌系统放射科医师联合对我院2009年1月至2018年5月经手术病理证实的16例PLB患者的影像资料进行回顾性分析。本组15例行X线检查、15例行CT检查(CT增强6例)、15例行MRI检查(增强14例),11例行SPECT骨显像检查。X线及CT征象观察指标包括:病变部位、骨质破坏类型、大小、软组织肿块、矿化密度影、病理骨折及骨膜反应。骨质破坏类型分为溶骨性、囊状性、混合性。骨膜反应分为Codman三角、层状及针状。MRI观察指标包括:病灶信号、大小、骨皮质突破、软组织肿块及瘤周水肿带;磁共振信号强度以周围正常肌肉为参考,分为低、等、高信号;增强扫描观察增强的形式。SPECT骨显像:以健侧部位的正常骨骼作为对照,SPECT骨显像信号高于正常骨骼称为放射性浓聚。结果16例PLB中,病变位于胫骨5例(近端4例、远端1例),股骨4例(远端3例、近端1例),肱骨(均在近端)、胸椎各2例,骶骨、耻骨、髂骨各1例。最大径2.0~14.5 cm,中位最大径5.2 cm。X线检查显示溶骨性骨质破坏8例,囊状2例,混合性4例,1例未见骨质异常。CT检查显示溶骨性9例,平扫密度不均匀,6例伴软组织肿块,其中3例伴部分硬化边、2例同时伴病理性压缩骨折且增强后明显强化、2例病变位于长骨中心者中1例伴骨膜反应;1例同时伴轻度骨膨胀、软组织肿块;2例伴部分硬化边。混合性4例,骨皮质均破坏、穿透,1例伴软组织肿块及骨膜反应、1例发生在长骨呈中心性生长并见骨膜反应、2例增强后明显不均匀强化(1例骨膨胀)。2例囊状性呈中心性生长,伴骨皮质破坏、穿透,1例伴软组织肿块、1例伴部分硬化边,增强后均明显不均匀强化。MRI检查T1WI呈等信号(10例)、略低信号(3例)、稍高信号(2例)信号,抑脂T2WI序列15Objective To analyze the radiological imagines and SPECT imaging features of primary leiomyosarcoma of bone and to improve the diagnostic level.Methods The imaging data of 16 patients in our hospital from January 2009 to May 2018 were retrospectively analyzed by two senior musculoskeletal radiologists,and they were all proved by surgery and pathology.The location of the lesions,type of bone destruction,size,soft tissue mass,mineralization,pathological fracture and periosteal reaction were detected by radiography and CT.The types of bone destruction are osteolytic,cystic and mixed.Periosteal reaction was divided into codman triangle,layered periosteal reaction and spiculate periosteal reaction.The signal intensity of lesions,size,distruction of the bony cortex,soft tissue mass and peritumoral edema were detected by MRI.Signal intensity was divided into low signal,iso-signal and high signal by taking surrounding normal muscles as reference.Enhancement scan was used to detect the form of enhancement.SPECT bone scan: compared with normal bone,SPECT bone scan signals were higher than normal bone,which was called concentrated radioactivity.Results Among the 16 cases,located in tibia(5 cases),femur (4 cases),sacrum(1 case),pubis(1 case),ilium(1 case),thoracic vertebra (2 cases) and humerus(2 cases).Radiography showed osteolytic,cystic and mixed bone destruction,among which 8 cases were osteolytic,2 cases were cystic,4 cases were mixed,and 1 case was normal.On CT images,9 cases were osteolytic,6 cases with soft tissue masses,among which 3 cases with partial sclerosis rim (2 cases with pathological fractare and obviously enhanced),1 case with mild bone expansion and soft tissue,2 cases with partial sclerosis rim.Four cases were mixed,all with cortical bone destruction,penetration,1 case with soft tissue mass and periosteal reaction,1 case which in the long bone of the extremity was central in location with periosteal reaction.Two cases were obviously and heterogeneously enhanced atter the enhanced CT scanning (1 case with

关 键 词：平滑肌肉瘤 骨 磁共振成像 体层摄影术 X线计算机 

分 类 号：R738[医药卫生—肿瘤] R730.44[医药卫生—临床医学] R445.2