骨肿瘤与瘤样病变周围组织影像表现分析

The imaging features of surrounding changes caused by bone tumors and tumor-like lesions SHANGGUAN

目的分析骨肿瘤与瘤样病变引起的骨髓水肿（BME）和软组织水肿（STE）的影像表现，加强对此征象的认识。方法复习经手术病理证实的99例骨肿瘤与瘤样病变资料，将病变分成良性组和恶性组，观察病灶周围BME和STE范围、信号特点、是否有强化、BME区域在X线平片和（或）CT上是否有骨质硬化、有无关节积液等，比较BME和STE出现率及范围差异。采用Х^2检验对组间数据进行比较。结果良性组40例，恶性组59例。BME和STE在T1WI上呈低信号，脂肪抑制T2WI上为高信号；部分BME在T2WI上呈低信号，相应区域在X线平片和（或）CT上为骨质硬化，离病灶越近，密度越高，在脂肪抑制T2WI上信号越低。增强扫描BME、STE皆均匀强化。BME、骨质硬化出现率及BME、STE范围长径中位数良性组分别为57．5％（23／40）、25．0％（10／40）、2．7cm、1．3cm，恶性组分别为32．2％（19／59）、3．4％（2／59）、1．6cm、1．7cm，差异均有统计学意义（P值均〈0．05）；STE和关节积液出现率良性组分别为50．0％（20／40）、12．5％（5／40），恶性组分别为52．5％（31／59）、8．5％（5／59），差异无统计学意义（P值均〉0．05）；良性组内BME和STE出现率差异无统计学意义（P〉0．05）；恶性组内BME和STE的出现率差异有统计学意义（P〈0．05）。结论良性骨肿瘤与瘤样病变及恶性骨肿瘤周围均可出现BME和STE，良性组BME范围大于恶性组，恶性骨肿瘤STE范围大于良性组。

Objective To explore the imaging features of bone marrow edema （BME） and soft tissue edema （STE） caused by bone tumors and tumor-like lesions. Methods Ninety nine patients with bone tumors and tumor-like lesions which were proved by surgical pathology were reviewed. The patients were divided into benign and malignant groups. Evaluation parameters included the size and signal intensity of BME and STE, the features of enhancement, the bone sclerosis and its relation with BME, and joint effusion, et al. The data of two groups were analyzed by X2 test. Results There were 40 patients in benign group and 59 patients belonged to malignant group. BME and STE demonstrated low signal on Tj-weighted images and high signal on fat-suppressed T2-weighted images. Some BMEs demonstrated low signal on T2- weighted images, which corresponded to sclerosis on X-ray film and （or） CT. Both BME and STE demonstrated uniform enhancement. There were statistically significant differences between benign and malignant groups including the frequency of BME, sclerosis, the median of the size of the BME and STE （P〈0.05）,which were 57.5% （23/40）, 25.0% （10/40）, 2.7 cm, 1.3 cm, and 32.2% （19/59）, 3.4% （2/59） , 1.6 cm, 1.7 cm respectively. No significant differences between the frequency of STE, joint effusion in 2 groups （P 〉 0. 05 ）. Conclusions Both benign bone tumors and tumor-like lesions and malignant bone tumors can be accompanied by BME and STE. The size of BME in the benign bone tumors and tumor-like lesions is bigger than those in malignant ones, and the size of STE in malignant bone tumors is bigger than benign ones.