摘要
目的 探讨常规MRI检查及对比增强MRI对长骨高分化软骨肉瘤与内生软骨瘤的鉴别诊断价值.方法 选取经手术病理确诊的发生于长骨的 23 例高分化软骨肉瘤和 20 例内生软骨瘤患者的临床及影像学资料.患者的临床特征包括:年龄、性别、症状、病变所致疼痛、肿瘤长径、部位及位置.影像学特征包括:肿瘤边界、形态、钙化灶、信号强度、骨内膜扇形改变、皮质膨胀、骨皮质破坏、骨膜反应、对比增强、有无软组织肿块及邻近髓腔和周围软组织信号改变.结果 高分化软骨肉瘤长径较内生软骨瘤明显较大(7.9 cm vs 4.6 cm),其病灶所致疼痛明显高于内生软骨瘤(73.9%vs 15.0%).高分化软骨肉瘤在MR图像有更高的阳性发现率,差异有统计学意义(P<0.05):T1WI多为等信号[69.6%(16/23)vs 25.0%(5/20)],T1WI增强图像多房表现[82.6%(19/23)vs 40.0%(8/20)]、病灶内更易出现钙化灶[100%(23/23)vs 75.0%(15/20)]、骨皮质破坏[34.8%(8/23)vs 0%(0/20)]、软组织肿块形成[26.1%(6/23)vs 0%(0/20)]以及邻近髓腔和软组织异常信号[30.4%(7/23)vs 0%(0/20)].结论 病灶大小、病灶所致疼痛以及MRI常规及增强特征有助于鉴别高分化软骨肉瘤与内生软骨瘤.
Abstract
Objective To explore the value of conventional magnetic resonance imaging(MRI)and contrast-enhanced MRI in the differential diagnosis of well-differentiated chondrosarcoma and enchondroma in long bones.Methods This study retro-spectively included clinical and imaging data of 23 patients with well-differentiated Chondrosarcoma and 20 patients with enchon-droma,who were diagnosed by surgery and pathology.The following clinical findings were assessed,including the age,gender,symptoms,tumor length,the location of tumors,and their occurrence in the bones.Imaging features included the tumor bound-ary,morphology,calcification,signal intensity,intraosseous scallop-like impression,bone expansion,bone destruction,peri-osteal reaction,enhancement form,presence of soft tissue mass,and the signal changes in and around the adjacent medullary cavity.Results In terms of clinical characteristics,tumor length of well-differentiated chondrosarcoma is significantly larger than that of enchondroma(7.9 cm vs 4.6 cm),and the pain attributable to the lesion is significantly higher than that of enchon-droma(73.9%vs 15.0%).Well-differentiated chondrosarcoma has a higher positive detection rate than enchondromas on MRI im-ages(P<0.05):T1-weighted phase is mostly isosignal[69.6%(16/23)well-differentiated chondrosarcoma vs 25.0%(5/20)en-chondroma],T1-weighted enhanced image presents with multi-room manifestations[82.6%(19/23)vs 40.0%(8/20)],calcifi-cation[100%(23/23)vs 75.0%(15/20)],bone destruction[34.8%(8/23)vs 0%(0/20)],soft tissue mass[26.1%(6/23)vs 0%(0/20)],and abnormal signal of adjacent medullary cavity and soft tissue[30.4%(7/23)vs 0%(0/20)].Conclusion Tu-mor length,pain atributableto lesion,together with imaging features of conventional and contrast-enhanced MRI can help distin-guish well-differentiated chondrosarcoma from enchondroma.
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