直径<3cm的骨原发肿瘤的影像学特征(附57例分析)

The imaging characteristics of primary bone tumors less than 3 cm in diameter (an analysis of 57 cases)

目的 分析直径 <3cm的骨原发肿瘤的临床影像所见 ,探讨其影像学特征。方法 搜集 4 0 0例经手术病理和临床证实的骨原发肿瘤 ,对其中 5 7例最大直径 <3cm(最大直径 0 .6～ 3.0cm ,平均为 1.6cm)的骨原发肿瘤进行回顾性分析。其中男 33例 ,女 2 4例 ;年龄 3.5～ 80 .0岁 ,平均年龄2 5 0岁 ,其中 <14岁儿童 31例 ;5 7例中良性 5 5例 ,恶性 2例 ;5 7例均摄局部X线正侧位平片 ,16例同时行CT检查 ,7例同时行MR平扫。结果 骨瘤 10例 ,其中致密型 9例 ,松质型 1例 ;分别位于颅骨(6例 )、鼻窦 (3例 )、蝶骨大翼 (1例 ) ,X线、CT(6例 )均显示病灶边界清楚 ,呈骨性均一致密影 ;1例松质骨骨瘤位于左蝶骨大翼 ,CT表现为边界清楚的骨性不均一致密影 ,其内可见圆点状更高密度影 ,T1WI病灶表现为等～高不均一信号 ,T2 WI表现为低～等不均一信号 ,增强扫描病灶无强化。骨样骨瘤 6例 ,病灶分别位于股骨 (1例 )、胫骨 (4例 )、髋臼 (1例 ) ,X线、CT(2例 )显示瘤巢呈类圆形 ,其中 5例瘤巢内见高密度斑点影。成骨细胞瘤 1例 ,位于坐骨体部 ,X线、CT表现为圆形、边界清楚并有硬化的病灶 ,其内可见斑点状高密度影。软骨瘤 17例 ,其中 15例内生软骨瘤病灶分别位于指骨 (8例 )、趾骨 (4例 )、跖骨 (3例 )骨干一端 ,X线示肿瘤?

Objective To analyze the imaging findings of primary bone tumors less than 3 cm in diameter, and to evaluate their imaging characteristics. Methods Out of 400 cases of primary bone tumors, 57 cases less than 3 cm in diameter (0.6～3.0 cm, mean 1.6 cm) were retrospectively analyzed. There were 33 males and 24 females, and their age ranged from 3.5 to 80.0 years (mean 25.0 years). 31 of the 57 cases were younger than 14 years. 55 cases were benign tumors and 2 were malignant. Radiography was performed in all 57 cases, CT in 16 cases, and MR in 7. Results X-ray and CT of osteoma showed clearly demarcated and homogeneous bony density ( n =9) and inhomogeneous bony density with spot-like higher density within the lesion ( n =1). Inhomogeneous iso- or hyperintensity on T 1WI and hypo- or isointensity on T 2WI without contrast enhancement were demonstrated. X-ray and CT of osteoid osteoma ( n =6) revealed oval nidus and hyperdense spots within the nidus ( n =5). X-ray and CT of osteoblastoma ( n =1) showed a round lesion with clear and sclerosing border, and hyperdense spots were found within the lesion. Chondroma ( n =17) included enchondroma ( n =15) and ecchondroma ( n =2). Sclerosing border at the medullary aspect ( n =15) and cortical side ( n =10) was demonstrated in enchondroma, but absent at cortical side in 5 cases. The cortex was discontinued and sclerosing border was absent on X-ray film for ecchondroma ( n =2). Osteochondroma ( n =7) originated from tubular bone ( n =6) and flat bone ( n =1). The growth direction of the tumor opposed the adjacent joints in tubular bone and protruded into the spinal canal as a lobulated mass in tabular bone (left lamina of vertebra at L3). Chondroblastoma ( n =2) located at the proximal epiphysis of the tibia, presenting as a clear and sclerosing bordered oval and expanding lesion with bony destruction. Isointensity on T 1WI and heterogeneous iso- or high signal on T 2WI was revealed on MR imaging. X-ray, CT, and/or MR findings of ossifying fibroma ( n =1), non-ossifying fibroma ( n =6), fibrosarcoma ( n =1), hemangioma ( n =2), lipoma ( n =3), and myeloma ( n =1) were also reported. Conclusion Most primary small bone tumors were non-aggressive benign tumors with lower biologic activity, and their most common locations were at lower limbs, hands, and feet, and they often occurred in children. Most of the primary small bone tumors had typical imaging features.