骨盆骨肉瘤的影像学诊断

Imaging features of pelvic osteosarcoma

目的分析骨盆骨肉瘤的影像学表现,探讨其影像学特征和鉴别诊断。方法回顾手术病理证实的18例骨盆骨肉瘤,分析其发病情况、病理类型及影像学主要表现。结果 18例病理均为普通型骨肉瘤。X线表现为混合型12例,溶骨型4例,硬化型2例,放射状骨膜反应8例,肿瘤骨及瘤样钙化14例,软组织肿块6例。CT平扫15例全部显示出软组织肿块。MRI 10例均见软组织肿块,骨髓内及软组织肿块周围弥漫水肿,肿瘤骨及瘤样钙化在SWI上为低信号。发射型计算机体层摄影表现浓聚范围较病变范围广泛。DSA表现为病灶部位血流丰富,大量新生肿瘤血管。结论骨盆骨肉瘤发病年龄较大,男女差别不明显,病理类型以普通型骨肉瘤为主,影像学表现以混合型骨肉瘤为主,骨膜反应以放射状为主。磁敏感加权成像有利于反映肿瘤骨和钙化。

Objective To analyze the imaging manifestations of the pelvic osteosarcoma and to explore its imaging char‐acteristics and differential diagnosis .Methods We retrospectively analyzed the clinical data of18 cases of pelvic osteosar‐coma confirmed pathologically ,in terms of incidence ,pathology ,and major imaging features .Results Pathologically , those 18 cases were all common osteosarcoma .X‐ray showed a mixed pattern in 12 cases ,the osteolytic type in 4 cases , the hardening type in 2 cases ,radial periosteal reaction in 8 cases ,bone tumors and tumor‐like calcification in 14 cases ,the soft tissue masses in 6 cases .CT scan showed that all 15 cases exhibited soft tissue mass .MRI showed that 10 cases pres‐ented with soft tissue mass and bone marrow and soft tissue mass were surrounded with diffuse edema .Bone tumors and tumor‐like calcification appeared as low signal on SWI .Emission computed tomography revealed a wider range of the up‐take compared with diseases .DSA examination showed that the lesion site had rich blood ,a lot of fresh tumor vessels . Conclusion Pelvic osteosarcoma mostly occurs in the older .The gender gap is not obvious .The major pathologic type is conventional osteosarcoma .The major imaging manifestation is mixed osteosarcoma .Periostealreaction is radially orien‐ted .Susceptibility weighted imaging is in favor of reflecting the bone tumor and calcification .