颅面骨骨肉瘤的CT和MRI诊断及鉴别
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摘要
目的:探讨颅面骨骨肉瘤的CT和MRI征象。方法:收集2005年8月到2017年11月15例经手术病理证实的颅面骨骨肉瘤的术前CT(14/15)、MRI(6/15)资料,男女比3:2,平均年龄42.8岁。原发性骨肉瘤8例,继发性骨肉瘤7例。对病灶部位、边界、内部成分、瘤骨、周围软组织分别进行分析。结果:病灶位于上颌骨6例,下颌骨4例,鞍区2例,颞颌关节1例,同时累及颧骨及上颌骨、下颌骨1例,同时累及蝶骨和鞍区1例。CT图像显示所有病灶均有不同程度骨质破坏,骨皮质部分或全部突破,有瘤骨形成者7例,其中5例为团块状瘤骨。MRI平扫信号多样,强化均匀或不均。结论:颅面骨骨肉瘤均出现不同程度骨破坏,伴瘤骨的概率较高,且常继发于放疗后和长期的骨化性纤维瘤,CT+MRI可较好地鉴别骨肉瘤和多种良恶性骨病变。
Purpose: To investigate the CT and MRI findings of craniofacial osteosarcoma. Methods: Preoperative CT(14/15) and MRI(6/15) data of 15 cases of craniofacial osteosarcoma confirmed by surgical pathology results were collected from August 2005 to November 2017. There were 9 men and 6 women. Their mean age was 42.8 years old.There were 8 cases of primary osteosarcoma and 7 cases of secondary osteosarcoma. The location, boundary, internal composition, tumor bone and surrounding soft tissue of the lesions were analyzed respectively. Results: The location of the lesion was maxillary bone in 6 cases, mandible in 4 cases, sella region in 2 cases, temporomandibular joint in1 case,zygomatic bone and maxilla and mandible in 1 case, sphenoid bone and sella region in 1 case. CT images showed that all lesions were with different grades of bone destruction, partial or total breakthrough of the bone cortex; 7 cases with tumor bone formation, 5 of which were with tuberous tumor bone. The MRI signal intensity of the lesions were varied and uniform or uneven. Conclusions: There is different degree bone destruction in craniofacial osteosarcoma. Tumor bone is more often seen secondary to radiotherapy and long-term ossifying fibroma. Osteosarcoma and a variety of benign and malignant bone lesions can be well identified by CT and MRI.
Purpose: To investigate the CT and MRI findings of craniofacial osteosarcoma. Methods: Preoperative CT(14/15) and MRI(6/15) data of 15 cases of craniofacial osteosarcoma confirmed by surgical pathology results were collected from August 2005 to November 2017. There were 9 men and 6 women. Their mean age was 42.8 years old.There were 8 cases of primary osteosarcoma and 7 cases of secondary osteosarcoma. The location, boundary, internal composition, tumor bone and surrounding soft tissue of the lesions were analyzed respectively. Results: The location of the lesion was maxillary bone in 6 cases, mandible in 4 cases, sella region in 2 cases, temporomandibular joint in1 case,zygomatic bone and maxilla and mandible in 1 case, sphenoid bone and sella region in 1 case. CT images showed that all lesions were with different grades of bone destruction, partial or total breakthrough of the bone cortex; 7 cases with tumor bone formation, 5 of which were with tuberous tumor bone. The MRI signal intensity of the lesions were varied and uniform or uneven. Conclusions: There is different degree bone destruction in craniofacial osteosarcoma. Tumor bone is more often seen secondary to radiotherapy and long-term ossifying fibroma. Osteosarcoma and a variety of benign and malignant bone lesions can be well identified by CT and MRI.
引文
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[10]周茜,熊佶,姚振威,等.颅骨骨肉瘤的CT、MRI影像学诊断.中国医学计算机成像杂志,2014,20:121-125.
[2]Caron AS,Hajdu SI,Strong EW.Osteogenic sarcoma of the facial and cranial bones:a review of forty-three cases.Am J Surg,1972,122:719-725.
[3]Garrington GE,Scofield HH,Cornyn J,et al.Osteosarcoma of the jaws.Analysis of 56 cases.Cancer,1967,20:377-391.
[4]王悦平,陈一铭,季彤.头颈部骨肉瘤临床病理及预后分析.中国口腔颌面外科杂志,2017,15:349-353.
[5]Xi M,Liu MZ,Wang HX,et al.Radiation-induced sarcoma in patients with nasopharyngeal carcinoma:a single-institution study.Cancer,2010,116:5479-5486.
[6]Chargari C,Cosset JM.The issue of low doses in radiation therapy and impact on radiation-induced secondary malignancies.Bull Cancer,2013,100:1333-1342.
[7]韦正波,许坚.头颈部放疗诱发肉瘤的临床研究进展.实用癌症杂志,2015,30:1103-1106.
[8]段小慧,梁碧玲,袁小平,等.多层螺旋CT在颌骨骨肉瘤诊断中的价值.影像诊断与介入放射学,2008,17:147-150.
[9]冯崇锦冉炜李楚玉,等.放射性颌骨骨髓炎的临床特征与治疗.中华放射医学与防护杂志,2006,26:159-160.
[10]周茜,熊佶,姚振威,等.颅骨骨肉瘤的CT、MRI影像学诊断.中国医学计算机成像杂志,2014,20:121-125.