MR评价良性骨肿瘤及肿瘤样病变与恶性骨肿瘤周围水肿的不同
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摘要
目的分析良性骨肿瘤及肿瘤样病变与恶性骨肿瘤周围水肿的不同,以期有助于良恶性的鉴别。材料与方法回顾分析经手术证实的121例骨肿瘤和肿瘤样病变患者资料,依据病理将病变分成良性组及恶性组,观察并计算病灶周围的骨髓水肿及软组织水肿出现率、骨髓水肿及软组织水肿范围最大径与肿瘤范围最大径比值。采用非参数检验对组间数据进行统计学分析比较。结果良性组63例,恶性组58例。良恶性组骨髓水肿出现率无明显差异(65.08%、58.62%,χ~2=0.535,P>0.05);软组织水肿出现率恶性组大于良性组(81.03%、63.49%,χ~2=4.6,P<0.05)。对于骨髓水肿最大径与肿瘤最大径之比,良性组大于恶性组(比值中位数分别为0.69、0.425,P<0.05);对于软组织水肿最大径与肿瘤最大径之比,良性组与恶性组无明显差异(比值中位数分别为0.415、0.3,P>0.05)。结论良恶性骨肿瘤和肿瘤样病变周围均可出现骨髓与软组织水肿,但区别在于周围软组织水肿更多见于恶性骨肿瘤,周围骨髓水肿在良性组更为明显(骨髓水肿与肿瘤最大径的比值良性组大于恶性组)。
Objective: To analyze the differences of surrounding marrow and soft tissue edema between benign bone tumor-tumor-like lesions and malignant bone tumors, in order to help differentiate the benign and malignant. Materials and Methods: 121 cases of bone tumors and tumor like lesions confirmed by surgery were retrospective reviewed, according to pathology. The lesions were divided into the benign group and malignant group. The incidences of bone marrow and soft tissue edema around the lesion were analyzed. The ratio of the largest diameter of bone marrow and soft tissue edema to the largest diameter of tumor was calculated. The data of two groups were analyzed by non-parametrie test. Results:There were 63 patients in the benign group and 58 in the malignant group. There was no statistically significant difference of the incidence of bone marrow edema in the benign and malignant group(65.08%, 58.62%, χ~2=0.535, P>0.05); the incidence of soft tissue edema in the malignant group is greater than that in the benign group(81.03%, 63.49%, χ~2=4.6, P<0.05).For the ratio of the largest diameter of bone marrow edema to that of the tumor, the benign group is larger than the malignant group(the median of the ratio is 0.69, 0.425, P<0.05).For the ratio of thelargest diameter of soft tissue edema to the that of the tumor, there was no significant difference between benign and malignant group(the median of the ratio is 0.415,0.3, P>0.05). Conclusions: Bone marrow and soft tissue edema can be found surrounding around both the benign and malignant bone tumors, the differences are: soft tissue edema is more common in the malignant tumors, bone marrow edema is more pronounced in the benign group(The ratio of the largest diameter of bone marrow edema to the that of the tumor in the benign group is greater than that in the malignant group).
Objective: To analyze the differences of surrounding marrow and soft tissue edema between benign bone tumor-tumor-like lesions and malignant bone tumors, in order to help differentiate the benign and malignant. Materials and Methods: 121 cases of bone tumors and tumor like lesions confirmed by surgery were retrospective reviewed, according to pathology. The lesions were divided into the benign group and malignant group. The incidences of bone marrow and soft tissue edema around the lesion were analyzed. The ratio of the largest diameter of bone marrow and soft tissue edema to the largest diameter of tumor was calculated. The data of two groups were analyzed by non-parametrie test. Results:There were 63 patients in the benign group and 58 in the malignant group. There was no statistically significant difference of the incidence of bone marrow edema in the benign and malignant group(65.08%, 58.62%, χ~2=0.535, P>0.05); the incidence of soft tissue edema in the malignant group is greater than that in the benign group(81.03%, 63.49%, χ~2=4.6, P<0.05).For the ratio of the largest diameter of bone marrow edema to that of the tumor, the benign group is larger than the malignant group(the median of the ratio is 0.69, 0.425, P<0.05).For the ratio of thelargest diameter of soft tissue edema to the that of the tumor, there was no significant difference between benign and malignant group(the median of the ratio is 0.415,0.3, P>0.05). Conclusions: Bone marrow and soft tissue edema can be found surrounding around both the benign and malignant bone tumors, the differences are: soft tissue edema is more common in the malignant tumors, bone marrow edema is more pronounced in the benign group(The ratio of the largest diameter of bone marrow edema to the that of the tumor in the benign group is greater than that in the malignant group).
引文
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[14]Steen RG.Edema and tumor perfusion:characterization by quantitative1H MR imaging.Am J Roentgenol,1992,158(2):259-264.
[15]Panicek DM,Gatsonis C,Rosenthal DI,et al.CT and MR imaging in the local staging of primary malignant musculoskeletal neoplasms:Report of the Radiology Diagnostic Oncology Group.Radiology,1997,202(1):237-246.
[16]Duan SH,Ren CP.The value of MRI in the diagnosis of bone tumors and soft tissue tumors.Chin J CT&MRI,2018,16(5):131-133,150.段舒怀,任翠萍.MRI对骨肿瘤及软组织肿瘤的诊断价值.中国CT和MRI杂志,2018,16(5):131-133,150.
[17]Xu H.Diagnosis and treatment of bone tumor imaging and pathological correlation.The Pra J Cancer,2016,31(6):967-971.徐海.骨肿瘤影像学与病理学相关性研究.实用癌症杂志,2016,31(6):967-971.
[18]Wang XQ,Liu HG.Correlation between bone tumor imaging and pathology.Pra J Cancer,2017,32(1):156-158.王小清,刘贺国.骨肿瘤影像学与病理学的相关性研究.实用癌症杂志,2017,32(1):156-158.
[19]Yu ZX.Imaging features and diagnosistic value of spinal bone tumors of different pathological types.J Huan Nomal Univ(Med Sci),2018,15(6):171-174.余泽祥.不同病理类型脊柱骨肿瘤影像学特征及诊断价值分析.湖南师范大学学报(医学版),2018,15(6):171-174.
[2]Ma L,Meng QF.MRI manifestations,mechanisms and significance of peritumoral edema in malignant bone tumors.Chin J Bone Tumor&Bone Dis,2002,1(3):153-156.马玲,孟悛非.恶性骨肿瘤周围水肿的MRI表现、机制与意义.中国骨肿瘤骨病,2002,1(3):153-156.
[3]Kroon HM,Bloem JL,Holscher HC,et al.MR imaging of edema accompanying benign and malignant bone tumors.Skeletal Radiol,1994,23(4):261-269.
[4]James SLJ,Panicek DM,Davies AM.Bone marrow oedema associated with benign and malignant bone tumours.Eur J Radiol,2008,67(1):11-21.
[5]Janzen L,Logan PM,O'Connell JX,et al.Intramedullary chondroid tumors of bone:correlation of abnormal peritumoral marrow and soft-tissue MRI signal with tumor type.Skeletal Radiol,1997,26(2):100-106.
[6]Shinmura K,Ishida T,Goto T,et al.Expression of cyclooxygenase-2 in chondroblastoma:immunohistochemical analysis with special emphasis on local inflammatory reaction.Virchows Arch,2004,444(1):28-35.
[7]Wang Y.Analysis of the findings of DR,CT and MRI in the diagnosis of chondroblastoma.Chin J CT&MRI,2017,15(2):109-112.王毅.软骨母细胞瘤的DR、CT及MRI表现及诊断分析.中国CT和MRI杂志,2017,15(2):109-112.
[8]Yamamura S,Sato K,Sugiura H,Prostaglandin levels of primary bone tumor tissues correlate with peritumoral edema demonstrated by magnetic resonance imaging.Can,2015,79(2):255-261.
[9]Yang ZL,Wang WW,Chen HS.The value of MRI in the diagnosis of undifferentiated pleomorphic sarcoma of soft tissue.J Med Imaging,2018,28(10):1740-1744.杨自力,王伟唯,陈海松.MRI对软组织未分化多形性肉瘤的诊断价值.医学影像学杂志,2018,28(10):1740-1744.
[10]James SLJ,Hughes RJ,Ali KE,et al.MRI of bone marrow oedema associated with focal bone lesions.Clin Radiol,2006,61(12):1003-1009.
[11]Zhang XL,Wu G,Xie RY,et al.The value of MRI intravoxel incoherent motion imaging(IVIM)and diffusion kurtosis imaging(DKI)in the differential diagnosis of benign and malignant bone and soft tissue tumors of lower extremeity.Chin J Magn Reson Imaging,2018,9(7):525-532.张晓莉,吴刚,谢如意,等.体素内不相干运动成像和扩散峰度成像在下肢良恶性骨与软组织肿瘤鉴别诊断中的价值.磁共振成像,2018,9(7):525-532.
[12]Chen HS,Han Y,Geng Q,et al.The differential diagnosis between benign and malignant bone tumors.Chin J Magn Reson Imaging,2014,5(4):291-295.陈海松,韩燕,耿青,等.良恶性骨肿瘤的MRI鉴别诊断.磁共振成像,2014,5(4):291-295.
[13]Jiang Q,Jiang H,Ding XY,et al.Dynamic contrast-enhanced MRimaging of osteosarcoma for evaluation of differential dignosis edema with tnnlor perfusion.Chin J Med Computed Imaging,2001,7(6):401-405.姜前,江浩,丁晓毅,等.MRI动态增强在鉴别原发性骨肉瘤与瘤周水肿的价值(与病理标本对照).中国医学计算机成像杂志,2001,7(6):401-405.
[14]Steen RG.Edema and tumor perfusion:characterization by quantitative1H MR imaging.Am J Roentgenol,1992,158(2):259-264.
[15]Panicek DM,Gatsonis C,Rosenthal DI,et al.CT and MR imaging in the local staging of primary malignant musculoskeletal neoplasms:Report of the Radiology Diagnostic Oncology Group.Radiology,1997,202(1):237-246.
[16]Duan SH,Ren CP.The value of MRI in the diagnosis of bone tumors and soft tissue tumors.Chin J CT&MRI,2018,16(5):131-133,150.段舒怀,任翠萍.MRI对骨肿瘤及软组织肿瘤的诊断价值.中国CT和MRI杂志,2018,16(5):131-133,150.
[17]Xu H.Diagnosis and treatment of bone tumor imaging and pathological correlation.The Pra J Cancer,2016,31(6):967-971.徐海.骨肿瘤影像学与病理学相关性研究.实用癌症杂志,2016,31(6):967-971.
[18]Wang XQ,Liu HG.Correlation between bone tumor imaging and pathology.Pra J Cancer,2017,32(1):156-158.王小清,刘贺国.骨肿瘤影像学与病理学的相关性研究.实用癌症杂志,2017,32(1):156-158.
[19]Yu ZX.Imaging features and diagnosistic value of spinal bone tumors of different pathological types.J Huan Nomal Univ(Med Sci),2018,15(6):171-174.余泽祥.不同病理类型脊柱骨肿瘤影像学特征及诊断价值分析.湖南师范大学学报(医学版),2018,15(6):171-174.