恶性骨巨细胞瘤的影像学表现  

IMAGING FINDINGS OF MALIGNANT GIANT CELL TUMOR OF BONE

作　　者：臧玉伟 娄和南 张亮[1] 陈海松[1] 林吉征[1] ZANG Yuwei;LOU Henan;ZHANG Liang;CHEN Haisong;LIN Jizheng(Department of Radiology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院放射科,山东青岛266003 [2]沂水县人民医院影像科

出　　处：《青岛大学学报（医学版）》2021年第1期13-18,共6页Journal of Qingdao University(Medical Sciences)

基　　金：国家自然科学基金资助项目(81571673)。

摘　　要：目的分析恶性骨巨细胞瘤(MGCTB)的影像学特征,提高其诊断准确率。方法回顾性分析12例经手术病理证实的MGCTB的影像学征象。结果12例MGCTB中,发生于膝关节3例,累及骨端,横向生长;发生于髋关节2例,侵犯骶髂骨、髋臼;发生于脊柱7例,呈偏心性生长,累及一侧附件区,3例呈压缩性改变。X线均示膨胀性溶骨性骨质破坏,局部见小斑片状骨膜反应。CT均示肿瘤周边不完整骨性包壳,边界不清,软组织包块均突出于骨壳之外,密度混杂;肿瘤呈皂泡状,内多发不规则骨嵴影。MRI示肿瘤均呈混杂T1、T2信号,内部见多发小囊状影,在T2WI上伴有更高信号区;3例病变多发条索状长T1、短T2信号影;MR增强示肿瘤明显不均匀强化。结论MGCTB保留有良性骨巨细胞瘤的部分特点,如典型的发病部位、皂泡状外观、肿瘤内部骨嵴及周边骨壳、膨胀性溶骨性骨质破坏等,但MGCTB的骨嵴排列杂乱,形态不规则,骨壳不完整且见软组织突出,X线可见骨膜反应,MRI可见低信号索条影,以上特征有助于本病诊断。Objective To investigate the imaging findings of malignant giant cell tumor of bone(MGCTB),and to improve its diagnostic accuracy.Methods A retrospective analysis was performed for the imaging findings of 12 patients with pat-hologically confirmed MGCTB.Results Among the 12 patients,3 had lesions in the knee joint that involved the bone end and showed lateral growth;2 had lesions in the hip joint that involved the sacro-iliac bones and the acetabulum;7 had lesions in the spine that showed eccentric growth and involved the adnexa area at one side,among whom 3 patients showed compression changes of the vertebral body.X-ray showed expansible osteolytic bone destruction and local patchy periosteal reaction.CT scan showed incomplete bony shell and unclear boundary around the tumor,and soft tissue mass protruded from the bony shell and showed inhomogeneous density.The tumors had the shape of soap bubbles and irregular shadow of bone crest.MRI scan showed that the tumor had heterogeneous intensity on T1WI and T2WI images,multiple cystic shadows,and hyperintensity on T 2WI images.Multiple linear long T1 and short T2 signals were observed in the lesions of 3 patients.Contract-enhanced MR showed heterogeneous enhancement of the tumors.Conclusion MGCTB has some imaging features of benign giant cell tumor of bone,such as typical lesion sites,the appearance of soap bubble,bone crest within tumor and bony shell around tumor,and expansible osteolytic bone destruction,but MGCTB has irregular arrangement and shape of bone crest,incomplete bony shell with soft tissue protrusion,pe-riosteal reaction on X-ray,and linear hypointensity signals on MRI,and these features may help with the diagnosis of this disease.

关 键 词：骨巨细胞瘤 体层摄影术 X线计算机 磁共振成像 诊断 

分 类 号：R445.2[医药卫生—影像医学与核医学] R738.1[医药卫生—诊断学]