MRI评价长骨中心型低度恶性软骨肉瘤早期侵袭性
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摘要
目的探讨MRI评价长骨中心型低度恶性软骨肉瘤早期侵袭性的价值。方法回顾性分析11例经手术病理证实为WHOⅠ级长骨中心型软骨肉瘤患者的资料,患者均于手术前2周内接受常规MRI。观察软骨肉瘤骨皮质内层浸润及髓腔内浸润的MRI表现。与手术病理对照,采用Kappa检验评价MRI诊断软骨肉瘤早期侵袭性与病理结果的一致性;计算MRI诊断软骨肉瘤骨皮质内层浸润及髓腔内浸润的敏感度、特异度和准确率。结果 MRI显示9例发生软骨肉瘤骨皮质内层浸润,其中6例骨皮质内层见不同程度扇贝样凹陷,3例骨皮质内层不同形式虫蚀样破坏;4例骨髓腔内浸润,表现为肿瘤边缘模糊、肿瘤周围骨髓出现异常信号。MRI诊断软骨肉瘤早期骨髓腔浸润和骨皮质浸润与病理结果的一致性较好(Kappa=0.441、0.621,P均<0.05),诊断肿瘤骨皮质内层及髓腔内浸润的敏感度分别为90.00%(9/10)、60.00%(3/5),特异度为100%(1/1)、83.33%(5/6),准确率为90.91%(10/11)、72.73%(8/11)。结论 MRI对长骨中心型软骨肉瘤早期侵袭性有较高诊断价值。
Objective To explore the diagnostic value of MRI in evaluating early aggressiveness of low grade central chondrosarcoma in long bones. Methods Data of 11 patients with histopathologically proved WHO grade Ⅰ central chondrosarcoma in long bones were reviewed. All patients underwent conventional MRI within 2 weeks before operation. MRI findings of intracortical and intramedullary infiltration of chondrosarcoma were observed. Compared with surgical pathology, Kappa test was used to evaluate the consistency of MRI with pathology in diagnosis of early invasiveness of chondrosarcoma. The sensitivity, specificity and accuracy of MRI in diagnosis of intracortical and intramedullary infiltration of chondrosarcoma were calculated. Results MRI showed 9 cases of chondrosarcoma with intracortical infiltration, among them 6 cases showed different degrees of scallop-like depression in the inner bone cortex, 3 cases had different forms of worm-like destruction in the inner bone cortex. Four cases of intramedullary infiltration showed blurred tumor edges and abnormal signals in the bone marrow around the tumors. MRI diagnosis of early aggressiveness of intramedullary and intracortical infiltration had good consistency with histopathological findings(Kappa=0.441, 0.621, both P<0.05). The sensitivity of MRI in diagnosis of intracortical and intramedullary infiltration was 90.00%(9/10) and 60.00%(3/5), specificity was 100%(1/1) and 83.33%(5/6), accuracy was 90.91%(10/11) and 72.73%(8/11), respectively. Conclusion MRI plays an important role in detecting early aggressiveness of central chondrosarcoma in long bones.
Objective To explore the diagnostic value of MRI in evaluating early aggressiveness of low grade central chondrosarcoma in long bones. Methods Data of 11 patients with histopathologically proved WHO grade Ⅰ central chondrosarcoma in long bones were reviewed. All patients underwent conventional MRI within 2 weeks before operation. MRI findings of intracortical and intramedullary infiltration of chondrosarcoma were observed. Compared with surgical pathology, Kappa test was used to evaluate the consistency of MRI with pathology in diagnosis of early invasiveness of chondrosarcoma. The sensitivity, specificity and accuracy of MRI in diagnosis of intracortical and intramedullary infiltration of chondrosarcoma were calculated. Results MRI showed 9 cases of chondrosarcoma with intracortical infiltration, among them 6 cases showed different degrees of scallop-like depression in the inner bone cortex, 3 cases had different forms of worm-like destruction in the inner bone cortex. Four cases of intramedullary infiltration showed blurred tumor edges and abnormal signals in the bone marrow around the tumors. MRI diagnosis of early aggressiveness of intramedullary and intracortical infiltration had good consistency with histopathological findings(Kappa=0.441, 0.621, both P<0.05). The sensitivity of MRI in diagnosis of intracortical and intramedullary infiltration was 90.00%(9/10) and 60.00%(3/5), specificity was 100%(1/1) and 83.33%(5/6), accuracy was 90.91%(10/11) and 72.73%(8/11), respectively. Conclusion MRI plays an important role in detecting early aggressiveness of central chondrosarcoma in long bones.
引文
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[15] Lisson CS,Lisson CG,Flosdorf K,et al.Diagnostic value of MRI-based 3D texture analysis for tissue characterisation and discrimination of low-grade chondrosarcoma from enchondroma:A pilot study.Eur Radiol,2018,28(2):468-477.
[2] Flemming DJ,Murphey MD.Enchondroma and chondrosarcoma.Semin Musculoskelet Radiol,2000,4(1):59-71.
[3] Murphey MD,Walker EA,Wilson AJ,et al.From the archives of the AFIP:Imaging of primary chondrosarcoma:Radiologic-pathologic correlation.Radiographics,2003,23(5):1245-1278.
[4] Murphey MD,Flemming DJ,Boyea SR,et al.Enchondroma versus chondrosarcoma in the appendicular skeleton:Differentiating features.Radiographics,1998,18(5):1213-1237.
[5] Douis H,Parry M,Vaiyapuri S,et al.What are the differentiating clinical and MRI-features of enchondromas from low-grade chondrosarcomas?Eur Radiol,2018,28(1):398-409.
[6] Ferrer-Santacreu EM,Ortiz-Cruz EJ,González-López JM,et al.Enchondroma versus low-grade chondrosarcoma in appendicular skeleton:Clinical and radiological criteria.J Oncol,2012,2012:437958.
[7] Crim J,Schmidt R,Layfield L,et al.Can imaging criteria distinguish enchondroma from grade 1 chondrosarcoma?Eur J Radiol,2015,84(11):2222-2230.
[8] Eefting D,Schrage YM,Geirnaerdt MJ,et al.Assessment of interobserver variability and histologic parameters to improve reliability in classification and grading of central cartilaginous tumors.Am J Surg Pathol,2009,33(1):50-57.
[9] 蒋智铭.骨关节肿瘤和瘤样病变的病理诊断.上海:上海科学教育出版社,2008:34-52.
[10] 周建功,袁小东,马小龙,等.长骨中心型Ⅰ级软骨肉瘤与内生软骨瘤的影像鉴别诊断.中华放射学杂志,2014,48(11):926-929.
[11] Choi BB,Jee WH,Sunwoo HJ,et al.MR differentiation of low-grade chondrosarcoma from enchondroma.Clin Imaging,2013,37(3):542-547.
[12] Coninck TD,Jans L,Sys G,et al.Dynamic contrast-enhanced MR imaging for differentiation between enchondroma and chondrosarcoma.Eur Radiol,2013,23(11):3140-3152.
[13] Vanel D,Kreshak J,Larousserie F,et al.Enchondroma vs.chondrosarcoma:A simple,easy-to-use,new magnetic resonance sign.Eur J Radiol,2013,82(12):2154-2160.
[14] Douis H,Jeys L,Grimer R,et al.Is there a role for diffusion-weighted MRI (DWI) in the diagnosis of centralcartilage tumors?Skelet Radiol,2015,44(7):963-969.
[15] Lisson CS,Lisson CG,Flosdorf K,et al.Diagnostic value of MRI-based 3D texture analysis for tissue characterisation and discrimination of low-grade chondrosarcoma from enchondroma:A pilot study.Eur Radiol,2018,28(2):468-477.