长骨未分化多形性肉瘤的影像学表现(附20例报告)  

Imaging findings of undifferentiated pleomorphic sarcoma of long bone(20 cases report)

作　　者：李亚宁 姜永宏[1] 张玉婷[1] 刘正华[1] LI Yaning;JIANG Yonghong;ZHANG Yuting;LIU Zhenghua(Department of Radiology,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院影像科,西安710054

出　　处：《磁共振成像》2021年第5期81-84,共4页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的探讨长骨未分化多形性肉瘤的影像表现及特征,提高对该病的认识及影像诊断水平。材料与方法回顾性收集经手术病理证实的20例发生在长骨的多形性肉瘤临床及影像资料,分析X线、CT及MRI的影像特点。结果20例中发生于长骨干骺端15例(其中股骨颈5例,其他干骺端10例),发生于骨干5例。5例股骨颈者均表现为囊状骨质破坏,1例其内可见高密度影。5例骨干者表现为虫蚀状骨质破坏,沿骨纵轴生长,纵径远大于横径(5例纵径均大于横径)。发生于股骨远端及胫骨近端干骺端的表现为大片状骨质破坏,或骨质破坏区夹杂粗细不等的骨嵴,2例可见骨膜三角。磁共振T1加权像(T1 weighted image,T1WI)表现为以等信号为主的混杂信号,磁共振T2加权像(T2 weighted image,T2WI)表现为以高信号为主的混杂信号,磁共振T2压脂序列(fat suppreion-T2WI,FS-T2WI)病灶边缘多可见高信号,11例核磁检查中7例病灶边缘见高信号。20例中9例可见较大软组织肿块,范围明显超过骨质破坏区。结论发生在不同部位多形性肉瘤的X线、CT、MRI表现有不同的影像学特点,股骨颈者多表现为边界清楚的囊状骨质破坏;骨干者多表现为沿骨纵轴生长的虫蚀状骨质破坏;股骨远端及胫骨近端干骺端为大片状骨质破坏,夹杂粗细不等的骨嵴。磁共振T1WI表现为以等信号为主;T2WI表现为以高信号为主,FS-T2WI病灶边缘高信号有提示意义。Objective:To investigate the imaging features of undifferentiated pleomorphic sarcoma of long bone(BUPS).Materials and Methods:Collect clinical and imaging data of 20 cases(BUPS)confirmed by surgery and pathology in our hospital,imaging features were retrospectively analyzed.Results:Fifteen cases occurred in the Epiphysis(5 cases occurred in the neck of femur,10 cases occurred in the other epiphysis),5 cases occurred in the diaphysis.Cystic bone destruction was observed in all 5 cases of femoral neck,and high density shadow was seen in 1 case.The 5 cases of diaphysis presented worm etched bone destruction,which grew along the longitudinal axis of the bone,and the longitudinal diameter was much larger than the transverse diameter(all the 5 cases had greater longitudinal diameter than the transverse diameter).Large massive bone destruction occurred at the distal femur and the proximal tibia,or the area of bone destruction was mainly mixed up with thick bone crest of different thickness,and Codman,were observed in 2 cases.Magnetic resonance T1WI is a hybrid signal dominated by isosignals.T2WI showed mixed signals mainly with high signals,high signals were mostly seen at the edge of lesions.High signal cystic changes were observed at the lesion margins in 7 of 11 cases on FS-T2WI.Nine cases have large soft masses,soft tissue masses is larger than the area of bone destruction.Conclusions:The imaging features of BUPS in different parts are different.The femoral neck was mostly characterized by cystic bone destruction with clear boundaries.Most of the diaphysis presented as worm erosion bone destruction along the longitudinal axis of the bone.The metaphysis of distal femur and proximal tibia showed large lamellar bone destruction,interspersed with bone crest of different thickness.Magnetic resonance T1WI is dominated by isosignals.T2WI was mainly manifested by high signal,and high signal at the edge of lesion on FS-T2WI was suggestive.

关 键 词：骨未分化多形性肉瘤 恶性纤维组织细胞瘤 影像学诊断 磁共振成像 计算机体层成像 

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]