骨巨细胞瘤合并动脉瘤样骨囊肿的影像学表现分析
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摘要
目的:探讨骨巨细胞瘤(GCT)合并动脉瘤样骨囊肿(ABC)的影像学表现及鉴别特点,以提高其诊断水平。方法:回顾性分析经手术、病理证实的14例GCT合并ABC的影像学表现。所有患者均行X线检查,11例行CT检查,12例行MRI扫描,2例行全身骨显像。对其影像学表现和病理结果进行对照。结果:14例中,病灶位于股骨6例,胫骨3例,尺骨3例,腓骨1例,桡骨1例。X线及CT表现为膨胀性骨质破坏,病灶密度不均匀,皮质变薄或中断。肿瘤实质区T1WI呈等或低信号、T2WI呈以高信号为主的混杂信号,病灶内多伴囊变和液-液平面,病灶周围骨质水肿,增强扫描病灶大部分呈明显强化。全身骨现象主要表现为病变部位片状放射性核素浓聚,显影不均匀。结论:GCT合并ABC的CT、MRI表现具有一定特征,结合X线、全身骨显像检查,有助于提高该病的术前诊断准确率,为临床治疗方案的制订提供帮助。
Objective:To investigate the imaging features and differential features of giant cell tumor of bone(GCT) with secondary aneurysmal bone cyst(ABC) in order to improve the diagnostic level. Methods:The imaging findings of 14 cases of GCT combined with ABC were retrospectively analyzed. All the patients were examined by X-ray,11 by CT,12 by MRI,and 2 by ECT. The imaging findings and pathological results were compared. Results:Of the 14 patients,6 cases were located in the femur,3 cases in the tibia,3 cases in ulna,1 case in fibula,and 1 case in radius. X-ray and CT showed expansive bone destruction,uneven density of lesion,thinning or discontinuity of cortex. The tumor parenchyma showed an isointensity signal on T1 WI and a slightly high mixed signal on T2 WI. Most of the lesions were accompanied by cystic degeneration and fluid-fluid level,and the lesions around the focus were edema. Most of the lesions were enhanced obviously. ECT showed radionuclide concentration and uneven development in lesions. Conclusions:The CT and MRI manifestations of this disease have some characteristics,combined with X-ray and whole body bone scan,it is helpful to improve the accuracy of preoperative diagnosis of GCT with secondary ABC,and provide assistance for clinical decision-making.
Objective:To investigate the imaging features and differential features of giant cell tumor of bone(GCT) with secondary aneurysmal bone cyst(ABC) in order to improve the diagnostic level. Methods:The imaging findings of 14 cases of GCT combined with ABC were retrospectively analyzed. All the patients were examined by X-ray,11 by CT,12 by MRI,and 2 by ECT. The imaging findings and pathological results were compared. Results:Of the 14 patients,6 cases were located in the femur,3 cases in the tibia,3 cases in ulna,1 case in fibula,and 1 case in radius. X-ray and CT showed expansive bone destruction,uneven density of lesion,thinning or discontinuity of cortex. The tumor parenchyma showed an isointensity signal on T1 WI and a slightly high mixed signal on T2 WI. Most of the lesions were accompanied by cystic degeneration and fluid-fluid level,and the lesions around the focus were edema. Most of the lesions were enhanced obviously. ECT showed radionuclide concentration and uneven development in lesions. Conclusions:The CT and MRI manifestations of this disease have some characteristics,combined with X-ray and whole body bone scan,it is helpful to improve the accuracy of preoperative diagnosis of GCT with secondary ABC,and provide assistance for clinical decision-making.
引文
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[11]邓敏,李文彬,李梅,等.原发性与继发性动脉瘤样骨囊肿的MRI表现及MRI诊断价值[J].中国临床医学影像杂志,2008,19(2):117-120.
[12]陈容凤,徐嬿,安杰,等.骨巨细胞瘤继发动脉瘤样骨囊肿的影像诊断[J].实用医学影像杂志,2017,18(4):311-314.
[13]Hong WS,Sung MS,Kim JH,et al.Giant cell tumor with secondary aneurysmal bone cyst:a unique presentation with an ossified extraosseous soft tissue mass[J].Skeletal Radiol,2013,42:1605-1610.
[14]葛微,王亚捷,张扬,等.小儿骨巨细胞瘤并发动脉瘤样骨囊肿伴病理性骨折1例[J].中国临床医学影像杂志,2014,25(10):759-760.
[15]谢炜星,晋大祥,丁金勇,等.胸椎骨巨细胞瘤并动脉瘤样骨囊肿1例报道[J].中国脊柱脊髓杂志,2013,23(6):572-574.
[16]Alias H,Doris Lau SC,Loh CK,et al.Giant cell tumor of the ribs and aneurysmal bone cyst presenting with hemothorax in a child[J].J Pediatr Hematol Oncol,2017,39:e463-e465.
[2]Murphey MD,Nomikos GC,Flemming DJ,et al.From the archives of AFIP.Imaging of giant cell tumor and giant cell reparative granuloma of bone:radiologic-pathologic correlation[J].Radiographics,2001,21:1283-1309.
[3]夏林,吴杰,敬宗林.青少年尺骨骨巨细胞瘤合并动脉瘤样骨囊肿1例[J].医学影像学杂志,2017,27(9):1768.
[4]Jaffe HL,Lichtenstein L.Solitary unicameral bone cyst:with emphasis on the roentgen picture,the patholog ic appearance and the pathogenesis[J].Arch Surg,1942,44:1004-1025.
[5]Louis L MD.Aneurysmal bone cyst.A pathological entity commonly mistaken for giant‐cell tumor and occasionally for hemangioma and osteogenic sarcoma[J].Cancer,1950,3:279-289.
[6]Sciot R,Dorfman H,Brys P,et al.Cytogenetic-morphologic correlations in aneurysmal bone cyst,giant cell tumor of bone and combined lesions.A report from the CHAMP study group[J].Mod Pathol,2000,13:1206-1210.
[7]顾玉彪,许伟,宋玲娟,等.肱骨骨巨细胞瘤合并动脉瘤样骨囊肿并病理性骨折1例[J].中国中医骨伤科杂志,2014,22(10):65-66.
[8]蔡玖明,唐怀金.动脉瘤样骨囊肿的影像学表现及分析[J].广东医学院学报,2014,32(4):481-483.
[9]于海龙,孟庆瑞,徐晓昉.继发性动脉瘤样骨囊肿的影像学诊[J].中国实用医药,2011,6(10):60-61.
[10]陈利军,陈文静,杜建平.不规则骨原发性动脉瘤样骨囊肿的影像评价[J].中国CT和MRI杂志,2015,13(1):95-98.
[11]邓敏,李文彬,李梅,等.原发性与继发性动脉瘤样骨囊肿的MRI表现及MRI诊断价值[J].中国临床医学影像杂志,2008,19(2):117-120.
[12]陈容凤,徐嬿,安杰,等.骨巨细胞瘤继发动脉瘤样骨囊肿的影像诊断[J].实用医学影像杂志,2017,18(4):311-314.
[13]Hong WS,Sung MS,Kim JH,et al.Giant cell tumor with secondary aneurysmal bone cyst:a unique presentation with an ossified extraosseous soft tissue mass[J].Skeletal Radiol,2013,42:1605-1610.
[14]葛微,王亚捷,张扬,等.小儿骨巨细胞瘤并发动脉瘤样骨囊肿伴病理性骨折1例[J].中国临床医学影像杂志,2014,25(10):759-760.
[15]谢炜星,晋大祥,丁金勇,等.胸椎骨巨细胞瘤并动脉瘤样骨囊肿1例报道[J].中国脊柱脊髓杂志,2013,23(6):572-574.
[16]Alias H,Doris Lau SC,Loh CK,et al.Giant cell tumor of the ribs and aneurysmal bone cyst presenting with hemothorax in a child[J].J Pediatr Hematol Oncol,2017,39:e463-e465.