【摘要】 目的探讨以下腰痛为突出表现的肿瘤相关性低磷软骨病(TIO)骶髂关节的影像学及临床特点。资料与方法回顾性分析解放军总医院风湿科收治的以下腰痛为突出表现的11例TIO患者的骶髂关节X线、CT、MRI、奥曲肽显像、骨扫描及临床和实验室检查资料,同时分析接受手术治疗患者的肿瘤特点及随访结果。选择性别、年龄匹配的33例诊断为中轴性脊柱关节炎(a Sp A)患者,对骶髂关节4个象限的骨髓水肿和骨侵蚀进行评分,比较两组患者的MRI特点。结果 11例TIO患者中,7例接受手术治疗,病理结果提示磷酸盐尿性间叶肿瘤4例,骨纤维结构不良1例,梭形细胞肿瘤1例,骨纤维异常增殖1例。术后随访12~90 d,至随访终点7例患者症状均缓解,血磷均恢复至正常水平。11例TIO患者中,8例行骨盆X线检查,4例可见异常表现;7例行骶髂关节CT检查,4例可见异常表现;所有患者均行骶髂关节MRI检查,8例可见骨髓水肿,6例可见骨侵蚀。骶髂关节MRI显示TIO组骶骨部分骨髓水肿评分明显高于a Sp A组(P<0.05),髂骨部分骨髓水肿评分则明显低于a Sp A组(P<0.05),骶髂关节所有象限骨髓水肿、骨侵蚀的总评分及骶骨部分和髂骨部分分别的骨侵蚀评分差异无统计学意义(P>0.05)。结论对于非典型炎性腰背痛患者,尤其伴有骨代谢指标异常时,应考虑骨代谢性疾病包括TIO的可能;骶髂关节MRI有助于鉴别TIO和a Sp A。更多还原

【Abstract】 Purpose To study the imaging and clinical features of sacroiliac joints(SIJ) in tumor-induced osteomalacia(TIO) patients whose main manifestation was low back pain. Materials and Methods Eleven TIO patients with low back pain as prominent sign were collected and their clinical features, laboratory tests and image presentations were analyzed. Another 33 age and sex matched patients with axial spondyloarthritis(a Sp A) were collected. Bone marrow edema and bone erosion in the four quadrants of SIJ were scored and the MRI characteristics of patients in the two groups were compared. Results Among the 11 TIO patients, surgical resection of the tumors was performed in 7 patients, the pathology results indicated that the majority of tumors(4 of 7 patients) were phosphaturic mesenchymal tumors, in addition, 1 case of osteofibrous dysplasia, 1 case of fibrous dysplasia and 1 case of spindle cell tumor were found. Patients were followed up from 12 to 90 days after tumor resection, all patients’ symptoms were relieved, with normal serum phosphorus levels. There were 8 TIO patients receiving plain radiography(4 patients had abnormalities) and 7 patients receiving CT of SIJ(4 patients had abnormalities). SIJ MRI was performed for all patients. Bone marrow edema and erosions were found in 8 and 6 patients respectively. The median score of bone marrow edema of the sacrum was significantly higher in the TIO group compared with that in the a Sp A group(P<0.05), while the median score of bone marrow edema of the ilium was significantly lower(P<0.05). No significant difference was observed with regard to the median score on bone marrow edema and erosions of sacrum, erosions of ilium, as well as total erosions(P>0.05). Conclusion For patients with atypical low back pain, if accompanied with abnormal bone metabolism index, metabolic bone disease including TIO should be considered. SIJ MRI may contribute to differentiating TIO from a Sp A.更多还原