骨血管性恶性肿瘤的影像表现分析

Malignant Vascular Tumors of Bone: The Analysis of Imaging Findings

目的分析骨血管性恶性肿瘤的影像学表现特点,为临床影像学诊断提供参考。方法将2013年1月~2017年6月在我院接受治疗的6例骨血管性恶性肿瘤的影像学表现资料作为研究对象,运用回顾法进行分析;5例为单发性,病理回报2例为血管肉瘤,2例为上皮样血管内皮瘤,1例为低度恶性血管肿瘤;1例为多发性,病理回报为多发性恶性血管肿瘤。结果患者均为成年人,6例患者均行X线检查,4例行CT平扫1例行CT增强,4例行MRI平扫2例行MRI增强扫描,单发病灶均位于长骨,发生于骨端至骨干,多近骨端,主要表现依恶性程度加重相对明显,见有溶骨性骨质破坏(多为纯溶骨性)、骨皮质中断(病灶可突破皮质形成软组织肿块)、骨质不同程度膨胀但多为轻度,无论恶性程度如何,病灶边缘骨质硬化及骨膜反应均不明显,1例多发病灶弥漫侵犯脊柱骨盆肋骨,主要表现纯溶骨性骨质破坏,局部肋骨骨质膨胀、病理性骨折。结论骨血管性恶性肿瘤在临床上很少见,影像表现有一定的特征性与共性,将多种影像检查方法联合应用,可以对其同发生于其他组织的骨肿瘤的鉴别起到一定程度的作用,但确诊还需病理检查。

Objective To analyze the imaging features of malignant bone vascular tumors and to provide reference for clinical imaging diagnosis.Methods The imaging data of 6 cases of malignant bone vascular tumors were analyzed retrospectively.All of them were treated in our hospital from January 2013 to June 2017,including 5 single cases,2 of which were angiosarcoma,2 epithelioid angioendothelioma and 1 low-grade malignant vascular tumor.Another single case was multiple malignant vascular tumor in pathological report.Results All of the patients were adults and they were all X-ray examined,which includes 4 cases of CT plain scan,1 case of CT enhancement.4 cases of MRI plain scan and 2 cases of MRI enhancement.All single lesions were located in the long bone,which occurred from the bone end to the diaphysis,and most of the lesions were near the bone end.Most lesions showed osteolytic bone destruction,disruption of the bone cortex(the lesion can break through the cortex to form a soft tissue mass),and bone swelling of varying degrees(mostly mild).Regardless of the degrees of malignancy,the marginal bone sclerosis and periosteal reaction were not obvious.1 case of multiple lesions were diffusely invading the spine,pelvis and rib,with pure osteolytic bone destruction,local rib bone swelling and pathological fracture.Conclusion malignant vascular tumors of bone are uncommon.In the identification of other bone malignant tumors,a combination of multiple imaging methods can play a role to a certain degree.However,to confirm the diagnosis,a pathological examination is still required.