骨肉瘤的X线、CT和MRI诊断分析

Analysis of X-Ray,CT and MRI in the diagnosis of osteosarcoma

目的探讨骨肉瘤的X线、CT和MRI诊断价值,提高对原发性骨肉瘤的影像学认识。方法回顾53例经病理证实的原发性骨肉瘤的X线、CT或MRI检查资料。结果53例中经X线检查49例,正确率为89.8%;CT检查10例,正确率为90%;MRI检查32例,正确率为96.9%。骨肉瘤基本影像表现为骨质破坏、骨膜反应、瘤骨和软组织肿块。49例X线表现为成骨型19例,溶骨型13例,混合型17例;X线对骨质破坏、骨膜反应、软组织肿块、瘤骨和Codman三角的检出率分别为61.2%、95.9%、71.4%、73.5%和27.7%;10例CT表现均可见骨质破坏、软组织肿块及瘤骨,CT对骨膜反应、筛孔征和Codman三角的检出率为90%、90%和11%;CT对显示细小肿瘤骨和筛孔征最敏感,但对Codman三角的显示不如X线平片;32例MRI表现为骨髓腔内正常的骨髓高信号被肿瘤信号所取代,T1WI呈低～等信号,T2WI呈混杂信号,7例合并出血,24例中央坏死囊变,32例增强扫描均呈不均匀强化及瘤周可见水肿区。结论X线价廉物美,空间分辨力高,是骨肉瘤的首选检查方法,CT、MRI作为X线的补充,可以提供更丰富的诊断信息,对患者治疗方式的决策必须经MRI检查。X线、CT和MRI三者结合,可提高骨肉瘤影像诊断的准确性。

Objective To approach the value of X-Ray, CT and MR/in the diagnosis of osteosarcoma and to improve the understanding level of primary osteosarcoma. Methods Imaging of X-Ray, CT and/or MRI in 53 patients with primary osteosarcoma proved by pathology were reviewed. Results 49 patients were examined by radiography and the exact rate was 89.8%; 10 patients were examined with CT scan and the exact rate was 90%; 32 patients were examined with MRI scan and the exact rate was 96.6% rate. The fundamental imaging features of osteosarcoma were showed bone destruction, peri- osteal reaction, neoplastic bone and soft-tissue mass. Among 49 cases examined by radiography, osteoblastic pattern sarcoma was found in 19 cases, osteolytic pattern sarcoma was found in 13 cases and mixed pattern sarcoma was found in 17 cases. The detection rates of bone destruction, periosteal reaction, soft-tissue mass, neoplastic bone and Codman triangle by radiography were respectively 61.2%, 95.9%, 71.4%, 73.5%and 27.7%. All 10 cases with CT scan were showed bone destruction, soft - tissue mass and neoplastic bone. The detection rates of periosteal reaction, ＇sieve sign＇± and Codman triangle with CT scan were respectively 90%, 90% and l 1%. The tiny neoplastic bone and ＂sieve sign＂ were showed sensitively by CT, but Codman triangle was showed by radiography superior to CT.32 cases with MR/scan presented the normal marrow was replaced by the tumor, which was showed low to intermediate signal intensity on T1- weighted images and promiscuity signal intensity on T2-weighted images. 7 cases presented hemorrhage and 24 cases presented necrosis. All 32 cases presented uneven significant enhancement with contrast-enhanced MR/scan and presented hydropsia around the lesions. Conclusion Radiography is the first choice for diagnosing osteosarcoma. CT and MR/could provide more information than Radiography. MRI examination should be performed before surgical operation. Radiography combined with CT and MRIcan improve the diagnosing accuracy of osteosarcoma.