骨转移瘤的不典型影像学征象  

ATYPICAL IMAGING FEATURES OF BONE METASTASES

作　　者：房亚军 徐文坚[1] 孙士庆[1] 杨志涛[1] 陈海松[1] FANG Yajun;XU Wenjian;SUN Shiqing;YANG Zhitao;CHEN Haisong(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]青岛大学附属青岛市中心医院

出　　处：《青岛大学学报（医学版）》2023年第4期560-563,共4页Journal of Qingdao University(Medical Sciences)

基　　金：国家自然科学基金资助项目(81571673,81671658)。

摘　　要：目的探讨骨转移瘤的不典型影像学征象,以提高骨转移瘤的诊断正确率。方法回顾性分析骨转移瘤病人374例的影像资料,分析并确定骨转移瘤的不典型影像学征象。比较医学图像存储与传输(PACS)系统及诊断医师对出现不典型影像学征象的骨转移瘤的诊断正确率。结果374例骨转移瘤病人中,181例仅行CT检查,其中有40例骨转移瘤影像学征象不典型,包括似良性骨肿瘤的骨质膨胀伴硬化边6例、似骨岛的结节状高密度影9例、似原发骨肿瘤的针状骨膜反应或骨膜三角8例、似外伤性或骨质疏松性的椎体压缩骨折17例;41例仅行MRI检查,未发现骨转移瘤的非典型影像学征象;152例病人行CT与MRI两种检查,有20例骨转移瘤影像征象不典型,包括似骨感染的不均匀骨质硬化及边界不清弥漫性骨质破坏区5例、似红骨髓转换的骨髓信号弥漫性减低14例、似囊肿的T_(2)压脂序列高信号1例。熟悉骨转移瘤不典型影像学征象者对不典型骨转移瘤的诊断正确率明显提高(χ^(2)=16.5,P<0.05)。结论骨转移瘤影像学表现多种多样,熟悉骨转移瘤的不典型影像学征象,可明显减少误诊。Objective To improve the diagnostic accuracy of bone metastases via a retrospective analysis of atypical imaging findings of bone metastases.Methods A retrospective analysis was performed on the imaging data of 374 patients with bone metastases to identify the atypical imaging findings.A comparative analysis was performed on the diagnostic accuracy of bone metastases with atypical imaging findings between the picture archiving and communication system and the diagnosticians.Results Among the 374 patients with bone metastases,181 underwent computed tomography(CT)examination alone,of whom 40 had atypical imaging findings,including 6 cases of bone expansion with sclerotic margins resembling benign bone tumors,9 cases of nodular high-density shadows resembling bone islands,8 cases of spiculated periosteal reaction or periosteal triangle resembling primary bone tumors,and 17 cases of vertebral compression fractures resembling traumatic or osteoporotic fractures.Among the 374 patients with bone metastases,41 underwent magnetic resonance imaging(MRI)scan alone,and no one had atypical imaging fin-dings.Among the 374 patients with bone metastases,152 underwent combined CT and MRI examinations,of whom 20 had atypical imaging findings,including 5 cases of uneven osteosclerosis and diffuse bone destruction with unclear boundaries that resembled bone infections,14 cases of diffuse decreased bone marrow signal that resembled red marrow conversion,and 1 case of hypersignal with T_(2)fat suppression sequence that resembled cysts.Diagnosticians who were familiar with the atypical imaging findings of bone metastases had a significantly higher diagnostic accuracy(χ^(2)=16.5,P<0.05).Conclusion There are various imaging findings in bone metastases.Familiarity with the atypical imaging findings can significantly reduce misdiagnosis.

关 键 词：肿瘤转移 骨肿瘤 骨折 压缩性 骨囊肿 磁共振成像 

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