骨母细胞瘤的影像分析(附43例报告)

Radiologic-pathologic correlation of osteoblastoma

目的观察并分析骨母细胞瘤影像及病理，探讨如何选择合适的手术方式。方法对2008年1月～2012年3月经手术治疗的43例骨母细胞瘤的影像和病理资料进行分析总结。所有病例术前均曾行X线，其中41例行MRI检查，9例同时行cT检查。结果23例良性骨母细胞瘤，20例侵袭性骨母细胞瘤。其中15例侵袭性骨母细胞瘤术后复发或转移。有6例伴继发性动脉瘤样骨囊肿。骨质破坏区内见斑点状、斑片状高密度影者34例。侵袭性骨母细胞瘤中骨皮质完整者2例。良性骨母细胞瘤周围骨髓及肌肉等软组织水肿反应较重者15例。6例良性、侵袭性判别上病理与影像存在争议。结论轻度膨胀性骨质破坏，破坏区内见较多斑点状或斑片状高密度骨化影是骨母细胞瘤较具特征性的影像表现，骨皮质是否破坏中断是影像判断肿瘤是否有侵袭性的依据，骨母细胞增生活跃及出现巨型上皮样骨母细胞是侵袭性骨母细胞瘤的组织学诊断依据。当病理表现为良性骨母，而影像上骨皮质破坏中断时，应考虑根治性切除。应用影像学和病理学结合的方法可提高诊断的准确性，指导临床手术方式。

Objective To correlate imaging and pathological features of osteoblastoma. Methods Radiographs （43）, CT （9） and MRI （41） of 43 patients with pathologically proved osteoblastomas from January 2008 to March 2012 were reviewed. Results Of 43 patients, 23 were benign osteoblastomas, 20 were invasive osteoblastomas, 6 were associated with secondary aneurysmal bone cysts. There was controversy in classifying 6 patients based on both pathology and imaging findings. In 15/20 patients with invasive osteohlastomas, the tumors recurred or metastasized after surgery. Mottled patchy high densities were seen in the bone destruetion areas in 34 patients. The bone cortex was intact in 2 invasive osteoblastomas. In 15/23 benign osteoblastomas, marked surrounding bone marrow and soft tissue edema was noted. Conclusions Correlating imaging and pathology findings can improve the diagnostie accuracy of osteoblastomas.