CT和MRI诊断成人骨肉瘤的价值分析

Value of CT and MRI in the diagnosis of adult osteosarcoma

目的探讨CT和磁共振成像(MRI)诊断成人骨肉瘤的临床价值。方法回顾性纳入2015年1月至2019年12月郑州市骨科医院收治的临床确诊为成人骨肉瘤患者39例,其中行CT检查28例,行MRI检查24例,行CT联合MRI双项检查13例。记录骨肉瘤的影像学特征,比较CT、MRI、CT联合MRI双项检查骨肉瘤诊断准确率及骨肉瘤征象检出率。结果 28例骨肉瘤患者经CT检查确诊23例,图像可显示较高密度的软骨组织,大多数骨皮质显示密集的筛洞,髓腔内的肿瘤附近的皮质断裂处和肿块相连,形成瘤骨;24例骨肉瘤患者经MRI检查确诊20例,T1加权成像表现大多为低信号,小部分为等信号,且大部分信号不均匀;T2加权成像表现大多为局部高信号,且信号基本不均匀,部分坏死囊变,并见液平。CT联合MRI双项检查诊断骨肉瘤的准确率为100%(13/13),高于CT(82.14%,23/28)和MRI(83.33%,20/24),P<0.05;CT与MRI诊断骨肉瘤的准确率比较,差异未见统计学意义(P>0.05)。CT、CT联合MRI双项检查对肿瘤骨及骨膜反应的检出率为100%(28/28)、89.29%(25/28)、100%(13/13)、92.31%(12/13),高于MRI的0、70.83%(17/24),P<0.05;MRI、CT联合MRI双项检查对软组织肿块和瘤周水肿区的检出率为91.67%(22/24)、100%(24/24)、92.31%(12/13)、100%(13/13),高于CT的67.86%(19/28)、28.57%(8/28),P<0.05。结论 CT和MRI诊断骨肉瘤均具有较高的准确率,但二者联合检测诊断骨肉瘤的准确率更高,单项CT或MRI检查对骨肉瘤征象的检出各具优势,二者联合检查对骨肉瘤征象的检出率更高。临床采用CT联合MRI检查诊断骨肉瘤可提高临床诊断准确率,也能详细记录骨肉瘤征象,为骨肉瘤后续治疗方案的制定提供数据支持。

Objective To investigate the clinical value of CT and magnetic resonance imaging(MRI)in the diagnosis of adult osteosarcoma.Methods Thirty-nine patients with adult osteosarcoma treated in Zhengzhou Orthopaedic Hospital from January 2015 to December 2019 were retrospectively included,among them 28 cases underwent CT examination,24 cases underwent MRI examination,and 13 cases underwent CT combined with MRI examinations.The imaging features of osteosarcoma were recorded,the accuracy rate and detection rate of sign of osteosarcoma were compared among CT,MRI,and CT combined with MRI.Results Twenty-three of 28 patients with intraosseous tumor were diagnosed by CT examination.The images showed high density cartilage tissue,and most of the bone cortex showed dense sieve holes,the cortical rupture near the tumor in the medullary cavity was connected with the mass to form tumor bone.Twenty of 24 patients with osteosarcoma were diagnosed by MRI,and most of them were low signal on T1 weighted imaging,a small part was iso-intensity,and most of them were inhomogeneous.Most of the T2 weighted imaging manifestations were local high signal,basically uneven,some necrotic cysts,and the fluid level was seen.The accuracy rate of CT combined with MRI in the diagnosis of osteosarcoma was 100%(13/13),which were higher than 82.14%(23/28)of CT and 83.33%(20/24)of MRI(P<0.05);there was no significant difference in the accuracy of CT and MRI in diagnosing osteosarcoma(P>0.05).The detection rates of CT for tumor bone and periosteum reaction were 100%(28/28)and 89.29%(25/28),respectively,and these indexes of CT combined with MRI were 100%(13/13)and 92.31%(12/13),respectively,which were higher than 0 and CT combined with MRI 70.83%(17/24)of MRI examination(P<0.05);the detection rates of MRI for soft tissue mass and peritumoral edema were 91.67%(22/24)and 100%(24/24),respectively,and these indexes of were 92.31%(12/13)and 100%(13/13),which were higher than 67.86%(19/28)and 28.57%(8/28)of CT(P<0.05).Conclusions CT and MRI have higher accuracy in the diagnosis of osteosarcoma,however,the accuracy of the combined detection in the diagnosis of osteosarcoma is significantly better than that of CT or MRI alone.CT or MRI alone has its own advantages in the detection of osteosarcoma,but the detection rate of combination of them is higher for osteosarcoma.CT combined with MRI can be used in the clinical diagnosis of osteosarcoma,which can not only improve the accuracy of clinical diagnosis,but also record the signs of osteosarcoma in detail,so as to provide data support for the follow-up treatment of osteosarcoma.