富于巨细胞的骨肉瘤影像学诊断分析(附7例报告)

Analyses of the imaging diagnosis of giant cell-rich osteosarcoma(report of 7 cases)

目的分析总结7例富于巨细胞的骨肉瘤(GCRO)的影像学表现,并探讨其与典型骨肉瘤、骨巨细胞瘤的鉴别诊断。方法回顾性分析经病理证实的7例GCRO的影像学表现。结果 GCRO病变大部分发生于长骨干骺端,个别病例发生于不规则骨。X线表现为溶骨性骨质破坏,长骨病变呈偏心性生长,骨内病变纵径大于横径,少见骨膜反应,未见肿瘤骨形成。CT及MRI平扫显示软组织病变替代正常骨组织,骨外肿块较大;MRI信号混杂,T2WI见低信号边界,周围骨髓及软组织水肿明显,T1WI显示骨质破坏病变内不规则斑片状高信号骨髓组织残留。增强见丰富肿瘤血管,肿块实质成分不均匀明显强化。结论 GCRO影像学表现为溶骨性骨质破坏,与典型骨肉瘤及良性骨巨细胞瘤有区别,与恶性骨巨细胞瘤鉴别困难。

Objective To analyze and summarize the imaging findings of 7 patients with giant cell-rich osteosarcoma（ GCRO）and,also,to explore the differential diagnosis of the patients with typical osteosarcoma and giant cell tumor of bone. Methods Imaging findings of 7 patients with GCRO confirmed by pathology were retrospectively analyzed in this work. Results The most lesions of GCRO occurred in metaphysis of long bone and a few occurred in the irregular bone. The lesions in the long bone exhibited eccentric growth. The longitudinal diameter of lesion within the bone was larger than the transverse diameter,the periosteal reaction was rare,and the tumor bone formation was not found. CT and MRI plain scan showed normal bone tissue was replaced by soft tissue. The soft tissue mass out of the bone was larger. MRI signal was hybrid,T2 WI sequence showed the low signal boundary,the bone marrow and soft tissue edema around the lesion was obvious,and T1 WI sequence showed the irregular patchy high signal and bone marrow tissue residue in the destruction lesions. The enhanced examination showed the rich tumor blood vessels and the substantial component was uneven and enhanced obviously. Conclusion The imaging manifestation of GCRO is osteolytic destruction. dissolution of bone destruction. GCRO is distinct from typical osteosarcoma and benign giant cell tumor of bone and is difficult to be differentiated from the malignant giant cell tumor of bone.