影像学鉴别诊断可动脊柱浆细胞瘤与骨巨细胞瘤

Imaging differential diagnosis of plasmacytoma and giant cell tumor of bone in mobile spine

目的观察可动脊柱浆细胞瘤与骨巨细胞瘤的影像学表现,剖析鉴别诊断要点。方法回顾性分析经病理证实的39例浆细胞瘤(浆细胞瘤组)和34例骨巨细胞瘤(骨巨细胞瘤组)患者的临床及影像学资料。结果 2组患者年龄差异有统计学意义(t=11.63,P<0.001),性别差异无统计学意义(χ2=0.013,P=0.91)。34例浆细胞瘤和26例骨巨细胞瘤的骨质破坏主体位于椎体;13例浆细胞瘤和20例骨巨细胞瘤表现为膨胀性骨质破坏;5例浆细胞瘤和12例骨巨细胞瘤可见硬化边;2例浆细胞瘤和10例骨巨细胞瘤合并骨质硬化;12例浆细胞瘤和15例骨巨细胞瘤内可见残存骨棘;24例浆细胞瘤和19例骨巨细胞瘤合并压缩骨折;15例浆细胞瘤和21例骨巨细胞瘤突破骨皮质在硬膜外形成软组织肿块,其中13例浆细胞瘤和2例骨巨细胞瘤软组织肿块包绕脊髓生长。2组肿瘤骨质破坏形式、是否有硬化边、合并骨质硬化、是否形成硬膜外软组织肿块及软组织肿块是否包绕脊髓生长的差异均有统计学意义(P均<0.05),而肿瘤骨质破坏主体部位、合并残存骨棘及压缩骨折发生率差异均无统计学意义(P均>0.05)。结论可动脊柱浆细胞瘤与骨巨细胞瘤的影像学表现具有相似性,需结合肿瘤骨质破坏形式、骨质破坏周围硬化边、合并骨质硬化及硬膜外软组织肿块及其包绕脊髓生长情况进行鉴别诊断。

Objective To observe imaging features of plasmaeytoma and giant cell tumor of bone (GCT)in mobile spine, and to analyze the differential diagnosis points of these two tumors.Methods Imaging features of histopathologically proved plasmaeytoma in 39 patients (plasmaeytoma group)and GCT in 34 patients (GCT group)were retrospectively analyzed.Results Significant difference of patients age (t=11.63,P<0.001) was found,while no difference of gender (x^2=0.013,P =0.91)was detected between the two groups.Bone destruction of vertebral body was found in 34 plasmacytoma and 26 GCT patients,expansible bone destruction was found in 13 plasmacytoma and 20 GCT patients, sclerosis rim formation was observed in 5 plasmacytoma and 12 GCT patients,whereas bone scierosis was displayed in 2 plasmacytoma and 10 GCT patients,residual bone trabecula was found in 12 plasmacytoma and 15 GCT patients, compression fracture was found in 24 plasmaeytoma and 19 GCT patients.Epidurai mass formation was found in 15 plasmacytoma and 21 GCT patients,among them soft tissue mass encircling spinal cord growth pattern was observed in 13 plasmacytoma and 2 GCT patients,respectively.Significant differences of expansible bone destruction,sclerosis rim formation,bone sclerosis,epidural mass and their encircling spinal cord growth pattern were found (all P<0.05),while no difference of bone destruction location,residual bone trabeeula nor compression bone fracture (all P<0.05)was found between the two groups.Conclusion Imaging findings of plasmacytoma and GCT in mobile spine were similar.Differential diagnosis of plasmacytoma arid GCT need to consider the condition of expansible bone destruction,sclerosis rim,bone sclerosis,epidural mass and encircling spinal cord growth pattern.