股骨近段91例骨肿瘤临床及影像学分析
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摘要
目的:分析股骨近段骨肿瘤的临床特征及影像学表现,以提高对股骨近段骨肿瘤的认知及疾病诊断水平。方法:回顾2010年至2016年本院收治的资料完整的91例股骨近段骨肿瘤。总结分析患者的性别、年龄、病理类型及影像学表现。两名放射科诊断医师分别对DR、CT、MRI诊断骨肿瘤的价值进行评价。结果:原发肿瘤76例,转移瘤15例。男53例,女38例,年龄4~83岁,平均34.43岁。良性骨肿瘤47例,占51.65%;中间型骨肿瘤20例,占21.98%;恶性骨肿瘤24例,占26.37%。良性肿瘤平均发病年龄29(4~60)岁,常见病种有纤维结构不良、单纯骨囊肿。中间型肿瘤平均发病年龄为21(4~40)岁,常见病种有动脉瘤样骨囊肿、软骨母细胞瘤;恶性肿瘤平均发病年龄为59(36~83)岁,转移瘤最常见。CT和MRI骨肿瘤的诊断符合率均高于DR(P<0.05),CT和MRI的诊断符合率没有统计学意义(P>0.05)。结论:股骨近段骨肿瘤中,良性及中间型骨肿瘤多见,以未明确肿瘤性质的肿瘤为主;恶性骨肿瘤以转移瘤最多。CT和MRI股骨近段骨肿瘤诊断价值优于DR。
Objective: To deepen the understanding of bone tumours in proximal femur and to improve the diagnosis by analyzing the clinical and radiological features of bone tumours in proximal femur. Methods: Data of our tumor database were reviewed. There were 91 cases of bone tumours in proximal femur between 2010 and 2016. The pathological types,age and gender of patients,and radiological features were recorded. Two radiologists evaluated the DR,CT,MRI in diagnosing bone tumors according to inclusion and evaluation criteria. Results: There were 76 cases of primary tumors and 15 cases metastatic tumors. 53 were male and 38 were female. Age of onset varied from 4 to 83 years,the mean age was 34. 43 years old. There were 47 cases( 51. 65%) of benign tumors,20 cases( 21. 98%) of intermediate tumors and 24 cases( 26. 37%) of malignancy. The mean age of benign tumors was 29 years( range: 4 ~60 years). The most common tumor types were fibrous dysplasia and simple bone cyst. The mean age of intermediate tumors was 21 years( range: 4 ~ 40 years). The most common tumor types were aneurysmal bone cyst and chondroblastoma. The mean age of malignancy was 59 years( range: 36 ~ 83 years). The most common tumor types was metastasis. The CT and MRI in the diagnosis of bone tumor coincidence rate were higher than DR( P < 0. 05). There was no statistical significance for diagnostic accordance rate of CT and MRI( P > 0. 05). Conclusion: Benign and intermediate tumors are more common than the malignant ones among proximal femur tumors. Tumor of undefined neoplastic nature are common tumor type,and metastasis is the most common malignant tumor. CT and MRI in the diagnosis value of bone tumors are superior to the DR.
Objective: To deepen the understanding of bone tumours in proximal femur and to improve the diagnosis by analyzing the clinical and radiological features of bone tumours in proximal femur. Methods: Data of our tumor database were reviewed. There were 91 cases of bone tumours in proximal femur between 2010 and 2016. The pathological types,age and gender of patients,and radiological features were recorded. Two radiologists evaluated the DR,CT,MRI in diagnosing bone tumors according to inclusion and evaluation criteria. Results: There were 76 cases of primary tumors and 15 cases metastatic tumors. 53 were male and 38 were female. Age of onset varied from 4 to 83 years,the mean age was 34. 43 years old. There were 47 cases( 51. 65%) of benign tumors,20 cases( 21. 98%) of intermediate tumors and 24 cases( 26. 37%) of malignancy. The mean age of benign tumors was 29 years( range: 4 ~60 years). The most common tumor types were fibrous dysplasia and simple bone cyst. The mean age of intermediate tumors was 21 years( range: 4 ~ 40 years). The most common tumor types were aneurysmal bone cyst and chondroblastoma. The mean age of malignancy was 59 years( range: 36 ~ 83 years). The most common tumor types was metastasis. The CT and MRI in the diagnosis of bone tumor coincidence rate were higher than DR( P < 0. 05). There was no statistical significance for diagnostic accordance rate of CT and MRI( P > 0. 05). Conclusion: Benign and intermediate tumors are more common than the malignant ones among proximal femur tumors. Tumor of undefined neoplastic nature are common tumor type,and metastasis is the most common malignant tumor. CT and MRI in the diagnosis value of bone tumors are superior to the DR.
引文
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[13]Sun SQ,Geng Q,Li XF,et al.The invasive signs in benign bone lesions:comparative study of MRI,CT and radiography[J].J Clin Radiol,2016,35(2):267-271.[孙士庆,耿青,李晓飞,等.良性骨病变的侵袭征象-MRI,CT,X线平片对比研究[J].临床放射学杂志,2016,35(2):267-271.]
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[15]Yao FR,Hu S,Hu CH.Diagnostic value of 64-slice spiral CT multiplanar reconstruction in tumor and tumor-like lesions of the proximal femur[J].J Prac Radiol,2013,29(8):1303-1306.[姚飞荣,胡粟,胡春洪,等.64层CT多平面重建技术对股骨近段骨肿瘤及肿瘤样病变的诊断价值[J].实用放射学杂志,2013,29(8):1303-1306.]
[2]Fang SG.WHO(2013)classification of bone tumors[J].Chinese Journal of Bone and Joint,2013,2(07):419-420.[方三高.WHO(2013)骨肿瘤分类[J].中国骨与关节杂志,2013,2(7):419-420.]
[3]Subodh AS,Freny RK,Hemant RU.Computed tomographic features of fibrous dysplasia of maxillofacial region[J].Imaging Sci Dent,2011,41(1):23-28.
[4]Seung YL,Chin YC,Kyoung ML,et al.Determining the best treatment for simple bone cyst:A decision analysis[J].Clin Orthop Surg,2014,6(1):62-71.
[5]Rapp TB,Ward JP,Alaia MJ.Aneurysmal bone cyst[J].J Am Acad Orthop Surg,2012,20(40):233-241.
[6]Kafil AK,Shagufta Q,Prasenjit SR,et al.Cytological dignosis of chondroblastoma:diagnostic challenge for cytopathologist[J].BMJ Case Rep,2014,5(29):1-4.
[7]Erol B,Sofuluo,Topkar MO,et al.Long-term follow-up of long and flat bone eosinophilic granulomas managed only with biopsy[J].Acta Orthop Traumatol,2015,49(2):144-150.
[8]Sree HT,Atul B,Shinagare JP,et al.MRI features of extramedullary myeloma[J].AJR,2014,202(4):803-810.
[9]Hanrahan CJ,Christensen CR,Crim JR.Current concepts in the evaluation of multiple myeloma with MR imaging and FDG PET/CT[J].Radio Graphics,2010,30(1):127-142.
[10]Kong LY,Yu AH,Qian ZH,et al.CT findings of tumor or tumorlike lesions in femoral neck[J].Journal of Medical Imaging,2013,23(05):773-776.[孔令懿,于爱红,钱占华,等.股骨颈常见骨肿瘤和肿瘤样病变的CT诊断[J].医学影像学杂志,2013,23(05):773-776.]
[11]Huang XF,Wang Y,Deng XJ,et al.Imaging findings of bone benign fibrous histiocytoma(a report of 4 cases and review of the literature)[J].Modern Oncology,2010,18(25):357-360.[黄旭方,王毅,邓晓娟,等.骨良性纤维组织细胞瘤的影像学表现(附4例报道及文献复习)[J].现代肿瘤医学,2010,18(25):357-360.]
[12]Liu L,Li GM,Xiong J.et al.Compare the diagnostic value of primary bone tumors by DR,CT and MRI[J].Journal of North Sichuan Medical College,2014,29(6):557-560.[刘露,李光明,熊娟,等.DR、CT、MRI在原发性良、恶性骨肿瘤中的诊断价值比较[J].川北医学院学报,2014,29(6):557-560.]
[13]Sun SQ,Geng Q,Li XF,et al.The invasive signs in benign bone lesions:comparative study of MRI,CT and radiography[J].J Clin Radiol,2016,35(2):267-271.[孙士庆,耿青,李晓飞,等.良性骨病变的侵袭征象-MRI,CT,X线平片对比研究[J].临床放射学杂志,2016,35(2):267-271.]
[14]Wang TC,Zhang H,Wang Y.Application of multislice spiral CT combined with three-dimensional reconstructed post-processing techniques for the diagnosis of bone tumors[J].J Clinical Rehabilitative Tissue Engineering Research,2012,16(22):4177-4180.[王铁才,张皓,王瑶.多层螺旋CT三维重建后处理在骨肿瘤影像诊断中的应用[J].中国组织工程研究,2012,16(22):4177-4180.]
[15]Yao FR,Hu S,Hu CH.Diagnostic value of 64-slice spiral CT multiplanar reconstruction in tumor and tumor-like lesions of the proximal femur[J].J Prac Radiol,2013,29(8):1303-1306.[姚飞荣,胡粟,胡春洪,等.64层CT多平面重建技术对股骨近段骨肿瘤及肿瘤样病变的诊断价值[J].实用放射学杂志,2013,29(8):1303-1306.]