【摘要】 目的探讨软组织影像改变对骨髓炎和恶性骨肿瘤的鉴别诊断价值。方法通过回顾性分析,对57例骨髓炎和70例恶性骨肿瘤患者软组织异常 CT 和 MRI 征象进行界定、观察、记录和统计学比较。结果 57例骨髓炎患者中,CT 检查54例,MR 检查14例。CT 检查的54例中,软组织肿胀52例(Ⅰ度19例、Ⅱ度16例、Ⅲ度17例),脓肿样囊腔6例,软组织肿块5例,软组织内气体、脂液平面和窦道各1例。MR 检查的14例骨髓炎中,软组织肿胀14例(Ⅰ度2例、Ⅱ度6例、Ⅲ度6例),脓肿样囊腔(扩散加权成像均呈明显高信号)3例,软组织肿块和脂液平面各1例。70例恶性骨肿瘤患者中,CT 检查54例,MR 检查49例。CT 检查的54例中,软组织肿胀44例(Ⅰ度29例、Ⅱ度12例、Ⅲ度3例),软组织肿块49例,软组织肿块边缘残留骨壳或壳样钙化16例,软组织肿块内肿瘤骨或瘤软骨钙化25例。MR 检查的49例恶性骨肿瘤中,软组织肿胀46例(Ⅰ度21例、Ⅱ度17例、Ⅲ度8例),软组织肿块43例。骨髓炎组和恶性骨肿瘤组 CT 图像显示的软组织肿胀程度(Uc=4.1066,P<0.01)以及脓肿样囊腔(χ~2=4.4118,P<0.05)、肿块(χ~2=71.7037,P<0.01)、肿块边缘残留骨壳或壳样钙化(χ~2=18.7826,P<0.01)和肿块内肿瘤骨或瘤软骨钙化(χ~2=32.5301,P<0.01)出现比例差异具有统计学意义。MR 图像所示的软组织肿胀程度(Uc=2.5997,P<0.01)以及脓肿样囊腔(四格表确切概率 P=0.0092)和肿块(χ~2=29.8757,P<0.01)出现比例差异亦有统计学意义。结论软组织肿胀程度和软组织肿块对骨髓炎和恶性骨肿瘤鉴别具有一定价值。软组织肿块边缘残留骨壳或壳样钙化以及软组织肿块内肿瘤骨或瘤软骨钙化是恶性骨肿瘤的特异性征象。脓肿样囊腔、软组织内气体、脂液征和窦道是骨髓炎的可靠征象。更多还原

【Abstract】 Objective To investigate the value of the imaging findings of soft tissue abnormality in the differential diagnosis between osteomyelitis and malignant bone tumor.Methods The CT and MRI findings of soft tissue changes in 57 cases of osteomyelitis and 70 cases of malignant bone tumor were retrospectively defined,observed,recorded and statistically analyzed.Results In 57 cases of osteomyelitis, 54 cases were examined with CT,and soft tissue swelling was presented in 52 cases (degree Ⅰin 19 cases, degreeⅡin 16 cases,degree Ⅲin 17 cases).Abscess-like cysts in soft tissue occurred in 6 cases,masses in 5,air in 1,fat-fluid level in 1 and sinus tract in 1.Among 14 cases examined with MR imaging,soft tissue swelling was presented in all cases (degreeⅠin 2 cases,degree Ⅱin 6 cases and degree Ⅲin 6 cases). Abscess-like cysts appeared in 3 cases and showed high signal in diffusion weighted imaging, mass in Ⅰand fat-fluid level in 1.Among 54 cases examined with CT in 70 cases of malignant bone tumor, soft tissue swelling was presented in 44 cases (degreeⅠin 29 cases,degreeⅡin 12 cases,degreeⅢin 3 cases).Soft tissue masses appeared in 49 cases,bone shell and shell-like calcification in 16 cases and neoplastic bone and neoplastic calcified cartilage within soft tissue mass in 25 cases.Among 49 cases examined with MR imaging,soft tissue swelling was presented in 46 cases (degree Ⅰin 21 cases,degreeⅡin 17 cases and degree Ⅲin 8 cases),and soft tissue masses appeared in 43 cases.The degree of soft tissue swelling and the occurrence of abscess-like cyst,mass,bone shell or shell-liked calcification in the rim of mass,neoplastic bone or neoplastic calcified cartilage in masses showed significant difference(P<0.05 ) between osteomyelitis group and malignant bone tumor group on CT examination.The degree of Soft tissue swelling and the occurrence frequency of abscess-like cysts and mass were significantly different(P<0.05 ) between osteomyelitis group and malignant bone tumor group on MR examination.Conclusion The degree of soft tissue swelling and the presence of mass were valuable for the differential diagnosis.Bone shell or shell- liked calcification in the rim of mass and neoplastic bone or neoplastic calcified cartilage were specific imaging signs of malignant bone tumor.Abscess-like cysts,soft tissue air,fat-fluid level and sinus tract were specific signs of osteomyelitis.更多还原