骨肉瘤的X线、CT及MRI比较分析(附61例分析)

Comparative analysis of X-ray,CT and MRI manifestations of osteosarcoma(analysis of 61 cases)

目的:探讨原发性骨肉瘤的X线、CT和MRI表现及诊断价值。方法:经穿刺或手术病理证实的61例骨肉瘤患者,52例行X线检查,39例行CT检查,55例行MRI检查,其中23例行MRI动态增强检查。回顾性分析其影像学表现并与病理学表现进行对照分析。结果:本组61例骨肉瘤中成骨型13例,溶骨型21例,混合型27例。52例X线检查中有6例表现阴性,46例阳性表现中,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68.6%、89.7%、69.4%、71.2%和26.9%;39例CT表现均可见骨质破坏、软组织肿块及瘤骨,CT对骨质破坏、骨膜反应、软组织肿块、筛孔征、瘤骨和Codman三角的检出率为100%、84.7%、87.2%、92.1%、100%和12.8%;55例MRI表现为T1WI上呈低信号或等信号,T2WI上呈低信号～等信号或等信号～高信号,抑脂序列上呈高信号。MRI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85.5%、72.7%、100%、89.1%和16.4%。结论:X线空间分辨力高,但不易发现早期病变;CT对显示细小肿瘤骨和筛孔征最敏感;MRI可清楚显示瘤内复杂信号并准确地界定肿瘤范围,尤其可敏感发现早期病变。X线、CT和MRI三者结合,可以提高骨肉瘤的影像诊断准确性。

Objective：To explore the imaging features and the related diagnostic value of the X-ray plain film,CT and MRI of the osteosarcoma.Methods：Sixty one patients with osteosarcoma were proved pathologically.Of them,52 cases were examined by X-ray radiography,39 cases were examined with CT scan,and 55 cases were examined with MRI and 23 cases underwent contrast-enhanced MRI.The imaging features of osteosarcoma were analyzed and correlated with pathology.Results：Among 61 patients with osteosarcoma,osteoblastic sarcoma was found in 13 cases,osteolytic sarcoma in 21,and mixed sarcoma in 27.Of 52 cases examined by radiography,six presented negative and the detection rates of bone destruction,periosteal reaction,soft-tissue mass,neoplastic bone,and Codman triangle were 68.6%,89.7%,69.4%,71.2% and 26.9%,respectively;the detection rates of bone destruction,periosteal reaction,soft-tissue mass,＂sieve sign＂,neoplastic bone,and Codman triangle by CT were 100%,84.7%,87.2%,92.1%,100% and 12.8%,respectively.The neoplastic parts showed hypo-or iso-intensity on T1WI,hypo-,iso-or hyper-intensity on T2WI,and hyper-intensity on turbo STIR images.The detection rates of bone destruction,periosteal reaction,soft-tissue mass,neoplastic bone,and Codman triangle by MRI were 85.5%,72.7%,100%,89.1% and 16.4%,respectively.Conclusion：Plain film is affordable and spatial resolution is high,but not easily to find early lesion;CT could be more sensitive to show small neoplastic bone and ＂sieve sign＂;MRI could demonstrate complicated signal intensity in tumor,define the extent of osteosarcoma and involvement of soft tissue,especially detect the early lesion.Combining the X-ray,CT and MRI can improve the diagnostic accuracy of osteosarcoma.