X线表现阴性骨肉瘤的早期诊断

Early Diagnosis of Osteosarcoma in the X-ray Negative

目的:探讨X线平片表现为阴性的骨肉瘤的早期诊断方法。方法:回顾9例X线平片表现为阴性的骨肉瘤患者的临床表现及其所进行的X线、CT、MRI、血清学检查及穿刺活检,并对结果进行统计。结果:9例骨肉瘤患者的X线平片检查均未能提示骨肉瘤;其中6例患者行CT检查,仅有2例提示可疑骨肉瘤,占33.3%;9例患者的血清中碱性磷酸酶超出正常范围者仅为4例,占44.4%;7例患者进行了术前穿刺活检,全部提示骨肉瘤,确诊率100%;同样,9例患者的MRI检查全部提示可疑骨肉瘤,占100%。结论:骨肉瘤的早期X线平片可能无异常改变,对于膝关节周围不明原因疼痛而X线平片检查结果为阴性的年轻患者,不应该排除骨肉瘤的可能,这部分患者应该行相应部位的MRI检查或者穿刺活检,从而明确诊断。

Objective： To investigate the early diagnosis of osteosarcoma for patients with negative X-ray presentation. Methods： We reviewed the clinical symptoms of 9 osteosarcoma patients who were negative upon X-ray examination. The data we analyzed included results of X-ray, computerized tomography （CT）, magnetic resonance imaging （MRI）, serological examination and needle biopsy. The 9 osteosarcoma patients included 7 males and 2 females. Seven cases had tumors in the distal end of the femur and 2 cases had tumors in the proximal end of tibia. The patients＇ age ranged from 14 to 33 years, with an average of 19.8 years. The patients＇ chief complaint was indisposition of the knee joint and their symptoms lasted from 20 to 55 days, with an average of 39 days. Results： All 9 patients with osteosarcoma underwent X-ray examination, without positive indications. Six patients underwent CT scan and 2 of them （33.3%） showed a possibility of osteosarcoma. The serum level of alkaline phosphatase exceeded the normal range in 4 cases （44.4%）. Seven cases had needle aspiration biopsy, which confirmed the disease. All of the patients underwent MRI scan and the results indicated osteosarcoma, with a diagnosis rate of 100%. Eight cases had irregular low signals in T1WI and the boundary was acceptable. One case had irregular low signals in T1WI and T2WI and bright contrast with surrounding constit. None of the cases had obvious cortical destruction. Conclusion： Early stage osteosarcoma may not be apparent upon X-ray examination. Osteosarcoma should be considered in young patients with pain in the vicinity of the knee joint without any history of injury. MRI scan or needle aspiration biopsy should be employed to obtain the final diagnosis.