原发性骨恶性纤维组织细胞瘤的影像学诊断

Value of imaging in the diagnosis of primary malignant fibrous histiocytoma of bone

目的探讨原发性骨恶性纤维组织细胞瘤(PBMFH)的影像学改变,以及X线平片、CT及MRI不同影像学检查方法的应用价值。方法总结经病理证实的35例(PBMFH)的影像学表现,回顾性分析X线平片、CT及MRI的影像学特征,探讨其对(PBMFH)的诊断价值。结果(PBMFH)具备全部恶性骨肿瘤的影像学特征,表现呈多种多样。X线平片和CT常表现为偏心性、侵袭性、溶骨性长骨端骨质破坏,并伴超过溶骨破坏范围的软组织肿块,骨膜反应少见。MR影像改变以等T1、等T2信号为主,其中夹杂斑片状、囊状长T1、长T2信号,但缺乏特异性。结论X线平片是首诊骨肿瘤的主要手段;CT及MRI检查的价值则在于显示病灶范围、皮质破坏、内部坏死及致密残留骨或钙化等骨和软组织细微结构变化情况,特别是MRI还可作为监测病变化疗、放疗疗效及术后复发的重要手段。

Objective To investigate the imaging feature of primary malignant fibrous histiocytoma of the bone (PBMFH) by the conventional radiography, CT and MRI, and to evaluate these different imaging methods in its diagnosis. Methods The imaging data of conventional radiography, CT and MRI of 35 patients with pathologically confirmed PBMFH were retrospectively analyzed. Results Though the imaging appearance of PBMFH varied in different cases, all the imaging findings of malignant bone tumors were revealed. The common imaging appearance on the conventional radiography and CT were eccentric, aggressive, osteolytic destructions of various types located at the ends of extremities with extraosseous soft tissue masses, but periosteal reaction was rare. Heterogeneous signal intensities on T 1WI and T 2WI were common MRI changes but not specific. Conclusionprimary malignant bone fibrous histiocytoma, a rare primary malignant bone tumor, is most frequently located in the long bone. Conventional radiography is still the first and main choice and is taken as an essential means of diagnosis. CT and MRI are quite important in demonstrating the details and extent of the disease such as soft tissue, cortical destruction, periosteal reaction, calcification and necrosis. The imaging characteristics may be of value in differentiating MFH from the other malignant bone tumors. Furthermore, MRI may also be valuable in assessing the efficacy of chemotherapy and/or radiation therapy, as well as in distinguishing recurrence from postoperative or post radiation changes.