骨原发性恶性纤维组织细胞瘤的影像学诊断

Radiological Diagnosis of Primary Malignant Fibrous Histiocytoma of Bone

目的研究骨原发性恶性纤维组织细胞瘤(MFH)的影像学诊断。方法回顾性分析了16例MFH患者的X线和CT检查结果,及6例MFH患者的MR表现。结果(1)X线平片表现:16例均示不规则溶骨性骨质破坏,相邻骨皮质破坏;5例伴有膨胀性改变,4例骨质破坏边缘有断续性硬化,2例于骨质破坏区边缘出现断续骨膜反应;12例骨质破坏区周围出现弥漫性软组织肿胀。(2)CT表现:16例均示不规则、无结构溶骨性骨质破坏,局部被软组织密度肿块所替代,邻近骨皮质呈不规则虫噬样破坏,4例病灶内部或边缘可见少许残留致密骨嵴和骨质破坏边缘断续性硬化;12例骨质破坏区周围示软组织肿块,其中3例肿块内可见单发或多发囊状低密度区,未见钙化及残留骨结构;所有病例CT上未见明确骨膜反应。(3)MR表现:6例骨质破坏区均呈不均匀长T1长T2异常信号,其中夹杂斑片状或囊状更长T1长T2信号;6例骨皮质破坏并突破皮质形成软组织肿块。结论MFH影像学表现具有一定特征性,X线平片、CT和MRI结合有助于本病的诊断和鉴别诊断。

Objective To explore the radiological diagnosis of primary malignant fibrous histiocytoma （MFH） of bone. Methods Sixteen patients with biopsy-or surgery-confirmed MFH received both plain X-ray and CT examinations, among whom six patients simultaneously received MRI. The imaging features were analyzed and the differential diagnoses were assessed. Results （ 1 ） Plain X-ray findings： All these lesions showed irregularly osteolytic, accompanied by cortical destruction. Five patients had varied degrees of cortical expansion, 12 had large soft tissue masses adjacent to the lesions, and only 2 had pefiosteal reaction. （2） CT findings： All lesions were osteolytic areas but had no evidences that its internal architecture had been replaced by soft tissue mass, and the cortical adjacent to the lesions were permeative osteolysis. Four patients had internal or marginal crest within the lesions and marginal inconsecutive osteosclerosis. Twelve had large soft tissue masses but without any calcification and residual architecture adjacent to the lesions, among which 3 patients had solitary or multiple cystic attenuation areas within the masses. No clear pefiosteal reaction was observed on CT. （3） MRI findings ： All of lesions in 6 patients who received MRI showed inhomogeneous long T1 and long T2 abnormal signal intensity with soft tissue masses adjacent to the osteodestructions. Conclusions The imaging manifestations of MFH were specific to some extent. Combined utilization of plain X-ray, CT, and MRI is helpful for the diagnosis and differential diagnosis of MFH.