富于巨细胞型骨肉瘤SPECT/CT影像学表现

SPECT/CT Imaging Features of Giant Cell-rich Osteosarcoma

目的探讨分析富于巨细胞型骨肉瘤(GCRO)的影像学特征,以提高对该病的诊断水平。方法回顾性分析我院经过病理证实的2例GCRO患者资料并进行文献总结,总结该病的临床、病理及影像特征,并随访最终结局。结果男性患者1例,38岁,股骨旁GCRO,女性患者1例,76岁,股骨近端髓腔型GCRO。(1)骨旁GCRO的影像表现:病变位于骨旁,DR表现为骨旁软组织内钙化影,形态不规则;CT表现为骨旁密度不均匀的肿块,内见位于肿块基底部的不规则团状钙化或骨化影,肿块约包绕股骨干的90%;全身骨显像及SPECT/CT融合图像表现为肿块内放射性核素异常浓聚。(2)髓腔型GCRO的影像表现:病变位于股骨近端,CT表现为膨胀性偏心性溶骨性骨质破坏,边缘不连,未见明显骨膜反应;全身骨显像及SPECT/CT图像表现为病变区边缘及中心区的不规则状放射性核素异常浓聚;结论GCRO罕见,影像学易误诊,常规影像学检查具有一定的特征性影像学表现,SPECT/CT结合常规影像学检查有助于诊断,确诊需结合多种影像学资料和组织病理学检查。

Objective To explore and analyze the imaging features of giant cell osteosarcoma(GCRO)in order to improve the diagnosis of GCRO.Methods The data of 2 pathologically confirmed GCRO patients in our hospital were retrospectively analyzed and the literature was summarized to summarize the clinical,pathological and imaging characteristics of the disease,and the final outcome was followed up.Results There was a 38-year-old male patient with parafemoral GCRO and a 76-year-old female patient with proximal femoral medullary type GCRO.(1)Imaging manifestations of parasosseous GCRO:the lesions were located near the bone,and DR Showed calcification shadows in the parasosseous soft tissues with irregular shape;CT showed an uneven parossial mass with irregular mass of calcification or ossification at the base of the mass.The mass covered about 90%of the femoral shaft.Whole body bone imaging and SPECT/CT fusion images showed abnormal concentration of radionuclides in the mass.(2)Imaging findings of medullary cavity GCRO:The lesion was located at the proximal femur,and CT findings showed dilatant eccentric osteolytic destruction without marginal union and no obvious periosteal reaction.The whole body bone imaging and SPECT/CT images showed irregular abnormal concentration of radionuclides at the edge and center of the lesion area.Conclusion GCRO is rare and easy to be misdiagnosed by imaging.Conventional imaging examination has certain characteristic imaging manifestations.SPECT/CT combined with conventional imaging examination is helpful for diagnosis.