核磁共振征象对尤文肉瘤和骨髓炎的鉴别诊断价值研究  

Significance of MRI signs for the differential diagnosis of Ewing sarcoma and osteomyelitis

作　　者：肖亚光 赵世龙[1] XIAO Ya-guang;ZHAO Shi-long(Department of Department,Zhongshan Hospital Affiliated to Dalian University,Dalian 116000,China)

机构地区：[1]大连大学附属中山医院放射科,大连116000

出　　处：《中国肿瘤临床与康复》2022年第1期20-23,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨核磁共振(MRI)征象对尤文肉瘤和骨髓炎的鉴别诊断价值。方法选取2014年1月至2020年12月间大连大学附属中山医院收治的接受MRI检查的44例尤文氏肉瘤和骨髓炎患者,均采用非增强T1加权(T1W)、T2加权(T2W)和脂肪抑制T2W序列及钆增强序列扫描,分析骨病变过渡区、软组织肿块、垂直于受累骨长轴的软组织肿块最长径、半影征、髓内或外脂肪球。以临床诊断为金标准,绘制MRI征象预测的灵敏度、特异性、准确率、阳性预测值、阴性预测值、曲线下面积(AUC)及95%CI,采用Kappa分析评估两名观察医师之间的一致性。结果两名医师的锐利过渡带骨病变、软组织肿块、髓内脂肪球缺失、髓外脂肪球缺失、半影征缺失等MRI征象结果分析,均有良好的一致性,差异均有统计学意义(均P <0.05)。软组织肿块(86.4%)是鉴别诊断尤文氏肉瘤和骨髓炎准确率最高的项目,其次是锐利过度带骨病变(72.7%);髓内脂肪球缺失、髓外脂肪球缺失和半影征缺失鉴别的准确性较低。23例存在软组织肿块的患者中,19例尤文氏肉瘤患者肿块平均直径为(41±21) mm,4例骨髓炎患者肿块平均直径为(24±11) mm,差异有统计学意义(P <0.05)。结论软组织肿块、锐利过渡带骨病变可能是鉴别尤文氏肉瘤和骨髓炎的MRI征象。Objective To investigate the significance of MRI signs for the differential diagnosis of Ewing sarcoma and osteomyelitis. Methods Forty-four patients with Ewing sarcoma and osteomyelitis who underwent MRI examinations were selected at Zhongshan Hospital Affiliated to Dalian University from January 2014 to December 2020. They received non-enhanced T1 weighting(T1W),T2 weighting(T2W) and fat suppression T2W sequences and gadolinium-enhanced sequence scan. Bone lesion zone of transition,soft tissue mass,longest diameter of soft tissue mass perpendicular to the long axis of the affected bone,penumbra and intramedullary/or extramedullary fat globules were analyzed. With clinical diagnosis as the gold standard,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value,area under the curve(AUC) and 95% CI of MRI signs prediction were plotted,and the Kappa analysis was used to evaluate the consistency between the two observation physicians. Results The results of sharp transitional bone lesions,soft tissue masses,loss of intramedullary fat globules,loss of extramedullary fat globules,and loss of penumbra showed good consistency in the analysis of MRI signs between the two doctors(all P <0. 05). The most accurate differential diagnosis of Ewing sarcoma and osteomyelitis is soft tissue mass(86. 4%) followed by sharp excessive bone lesions(72. 7%). The accuracy of intramedullary fat globule loss,extramedullary fat globule loss and penumbra loss differentiation was low. Among the 23 patients with soft tissue masses,19 patients with Ewing sarcoma had an average mass diameter of 41 ± 21 mm,and 4 patients with osteomyelitis had an average mass diameter of 24 ± 11 mm(all P < 0. 05). Conclusion Soft tissue masses and sharp transitional zone of bone lesions may be useful MRI signs for distinguishing Ewing sarcoma from osteomyelitis.

关 键 词：尤文氏肉瘤 骨髓炎 核磁共振 鉴别诊断 

分 类 号：R738.1[医药卫生—肿瘤]