骨小细胞恶性肿瘤的影像特征分析

Clinical and imaging characteristics of small cell malignant tumor of bone

目的分析骨小细胞恶性肿瘤(SCMT)的临床及影像表现,以提高临床诊断水平。方法回顾性选取经病理证实的骨SCMT病人75例,其中恶性非霍奇金淋巴瘤(MNHL)25例[男20例、女5例,平均年龄(50.0±18.3)岁],骨的浆细胞瘤(PB)37例[男20例、女17例,平均年龄(59.1±12.4)岁]、尤文肉瘤(ES)13例[男11例、女2例,平均年龄(17.1±6.7)岁]。分析3种肿瘤病人临床资料、病灶X线摄影或CT特征及MRI特征。采用单因素方差分析、卡方检验或Fisher确切概率检验比较3组病人的临床资料和影像特征分布。结果3组间年龄、性别、骨质破坏类型、骨皮质破坏类型、膨胀性改变和残留骨嵴、病灶周围水肿、软组织肿块、骨膜反应差异均有统计学意义(均P<0.05)。MNHL组及PB组病人的平均年龄均高于ES组,3组男性均多于女性。3组X线及CT特征中,PB组中骨质破坏、骨皮质破坏、膨胀性改变及病变内残留骨嵴征象的占比均高于其余2组;其中PB组病人均可见骨质破坏和骨皮质破坏(100%),且骨质破坏多呈溶骨性改变(90.6%),并以骨皮质缺损多见(84.4%)。3组MRI特征中,ES组出现病灶周围水肿、软组织肿块和骨膜反应的占比均最高,其次为MNH组和PB组。ES组出现软组织肿块的占比高达100%,MNHL组和PB组中出现骨膜反应者仅占5.6%和4.8%。3组发生部位、T2WI信号特点间的差异均无统计学意义(均P>0.05)。结论结合病人的年龄及影像学表现有助于鉴别骨SCMT。

Objective To improve clinical diagnosis through analyzing the clinical data and imaging manifestations of small cell malignant tumors(SCMT)of bone.Methods All of 75 patients with small cell malignant tumors of bone which were confirmed by histopathology were retrospectively selected,including 25 patients(20 males and 5 females,mean age50.0±18.3 years)with malignant non-Hodgkin lymphoma(MNHL),37 patients(20 males and 17 females,mean age 59.1±12.4 years)with plasmacytoma of bone(PB)and 13 patients(11 males and 2 females,mean age 17.1±6.7 years)with Ewing sarcoma(ES).The clinical data,X-ray/CT features and MRI features of the three groups were analyzed.One-way ANOVA,chi-square test or Fisher exact probability test were used to compare the clinical date and imaging features.Results There were significant differences in age,sex,types of bone and bone cortex destruction,change of expensive lesion,residual bone crest,peri-focal edema,soft tissue mass,and periosteal reaction among the three groups(all P<0.05).The average ages of MNHL and PB groups were larger than that of ES group.There were more males than females in each group.For the X-ray/CT features,the proportions of bone destruction,bone cortical destruction,change of expansive lesion,and residual bone crest were more common in the PB group than in the other groups.In the PB group,all patients presented bone destruction and cortical destruction(100%),and the bone destructions mostly were osteolytic changes(90.6%),and cortical defects were more common(84.4%).For the MRI features,the proportion of peri-focal edema,soft tissue mass,and periosteal reaction were more common in the ES group than in the other groups,and the proportion of soft tissue mass in ES group was the highest,which was up to 100%,and in the MNHL and PB groups,the proportion of periosteal reaction was only 5.6%and 4.8%respectively.There were no significant difference in location of lesions and signal intensity on T2 WI images among the three groups(all P>0.05).Conclusion The combination of age,and imaging findings of patients is helpful to distinguish SCMT of bone.