原发性骨血管肉瘤的影像表现与误诊分析

Imaging manifestation and misdiagnosis analysis of primary angiosarcoma of bone

目的探讨原发性骨血管肉瘤的影像表现,旨在提高其诊断水平。材料与方法对6例经病理证实的原发性骨血管肉瘤患者的影像资料进行回顾性分析。结果 4例单发(股骨2例,骶髂关节1例,脊柱1例),2例多发,表现为溶骨性骨质破坏,无硬化边,无骨膜反应,可见软组织肿块,T1WI上表现为不均匀低信号,T2WI上表现为不均匀高信号,增强扫描则呈显著不均匀强化。术前曾被误诊为骨巨细胞瘤、纤维骨皮质缺损、非骨化性纤维瘤、结核、转移瘤、骨髓瘤。结论原发性骨血管肉瘤的影像表现具有一定特征,溶骨性骨质破坏位于骨皮质和(或)髓腔,多边界不清,一般无硬化边,病变骨可有不同程度的膨胀,软组织肿块常见,骨膜反应少见,多中心病灶对诊断具有指导意义。

Objective:To explore imaging manifestation of primary angiosarcoma of bone,and to improve the diagnostic accumcy of the disease.Materials and Methods:The imaging materials of 6 patients with primary angiosarcoma of bone proved by pathology were reviewed retrospectively.Results:There were 4 cases who had a single lesion and the other had multiple lesions.Among 4 cases who had a single lesion,2 cases were located in femur,1 case in sacroiliac joint and 1 case in vertebral column.The imaging characteristics included the osteolytic destruction and soft tissue swelling or mass,no sclerotic rim,no periosteal proliferation.Had been misdiagnosed as giant cell tumor of bone,fibrous cortical defect of bone,nonossifying fibroma,tuberculosis,metastatic neoplasm,multiple myeloma before operation.Conclusions:The radiologic appearances of primary angiosarcoma of bone have relative characteristics such as cortical and/or medullary osteolytic destruction,unclear borders,no hardened edge,different degrees of expansion,soft-tissue mass,with minimal periosteums reaction.In addition,multi-center lesions have guiding significance for the diagnosis of this disease.