长骨高分化软骨肉瘤与内生软骨瘤的临床及MRI影像特征对比分析  

Comparative study of clinical and MRI features of well-differentiated chondrosarcoma and enchondroma in long bones

作　　者：刘鸿利 蒋静 徐磊[1] 时寅 祁良[1] 冯阳[1] 邹月芬[1] 宗敏[1] LIU Hongli;JIANG Jing;XU Lei;SHI Yin;QI Liang;FENG Yang;ZOU Yuefen;ZONG Min(Department of Radiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Radiology,Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Nanjing 210001,China)

机构地区：[1]南京医科大学第一附属医院放射科,江苏南京210029 [2]南京中医药大学附属南京中医院放射科,江苏南京210001

出　　处：《医学影像学杂志》2024年第6期129-133,共5页Journal of Medical Imaging

摘　　要：目的探讨常规MRI检查及对比增强MRI对长骨高分化软骨肉瘤与内生软骨瘤的鉴别诊断价值。方法选取经手术病理确诊的发生于长骨的23例高分化软骨肉瘤和20例内生软骨瘤患者的临床及影像学资料。患者的临床特征包括:年龄、性别、症状、病变所致疼痛、肿瘤长径、部位及位置。影像学特征包括:肿瘤边界、形态、钙化灶、信号强度、骨内膜扇形改变、皮质膨胀、骨皮质破坏、骨膜反应、对比增强、有无软组织肿块及邻近髓腔和周围软组织信号改变。结果高分化软骨肉瘤长径较内生软骨瘤明显较大(7.9 cm vs 4.6 cm),其病灶所致疼痛明显高于内生软骨瘤(73.9%vs 15.0%)。高分化软骨肉瘤在MR图像有更高的阳性发现率,差异有统计学意义(P<0.05):T_(1)WI多为等信号[69.6%(16/23)vs 25.0%(5/20)],T_(1)WI增强图像多房表现[82.6%(19/23)vs 40.0%(8/20)]、病灶内更易出现钙化灶[100%(23/23)vs 75.0%(15/20)]、骨皮质破坏[34.8%(8/23)vs 0%(0/20)]、软组织肿块形成[26.1%(6/23)vs 0%(0/20)]以及邻近髓腔和软组织异常信号[30.4%(7/23)vs 0%(0/20)]。结论病灶大小、病灶所致疼痛以及MRI常规及增强特征有助于鉴别高分化软骨肉瘤与内生软骨瘤。Objective To explore the value of conventional magnetic resonance imaging(MRI)and contrast-enhanced MRI in the differential diagnosis of well-differentiated chondrosarcoma and enchondroma in long bones.Methods This study retrospectively included clinical and imaging data of 23 patients with well-differentiated Chondrosarcoma and 20 patients with enchondroma,who were diagnosed by surgery and pathology.The following clinical findings were assessed,including the age,gender,symptoms,tumor length,the location of tumors,and their occurrence in the bones.Imaging features included the tumor boundary,morphology,calcification,signal intensity,intraosseous scallop-like impression,bone expansion,bone destruction,periosteal reaction,enhancement form,presence of soft tissue mass,and the signal changes in and around the adjacent medullary cavity.Results In terms of clinical characteristics,tumor length of well-differentiated chondrosarcoma is significantly larger than that of enchondroma(7.9 cm vs 4.6 cm),and the pain attributable to the lesion is significantly higher than that of enchondroma(73.9%vs 15.0%).Well-differentiated chondrosarcoma has a higher positive detection rate than enchondromas on MRI images(P<0.05):T_(1)-weighted phase is mostly isosignal[69.6%(16/23)well-differentiated chondrosarcoma vs 25.0%(5/20)enchondroma],T_(1)-weighted enhanced image presents with multi-room manifestations[82.6%(19/23)vs 40.0%(8/20)],calcification[100%(23/23)vs 75.0%(15/20)],bone destruction[34.8%(8/23)vs 0%(0/20)],soft tissue mass[26.1%(6/23)vs 0%(0/20)],and abnormal signal of adjacent medullary cavity and soft tissue[30.4%(7/23)vs 0%(0/20)].Conclusion Tumor length,pain atributableto lesion,together with imaging features of conventional and contrast-enhanced MRI can help distinguish well-differentiated chondrosarcoma from enchondroma.

关 键 词：内生软骨瘤 高分化软骨肉瘤 磁共振成像 

分 类 号：R738.3[医药卫生—肿瘤] R445.2[医药卫生—临床医学]