【作者】 李娜； 屈辉；

【Author】 Li Na QuHui Department of Radiology, Beijing Jishuitan Hospital, Beijing, China, 100035

【机构】 北京积水潭医院放射科；

【摘要】 目的:探讨四肢长骨皮质骨转移瘤的影像学表现, 评价影像学的诊断价值及对原发肿瘤部位的提示价值。方法: 回顾性分析2001年-2006年3月于我院收治的14例四肢长骨皮质骨转移瘤患者的影像学检查和临床病史。14例均行X 线平片检查,其中10例行CT检查,4例行MR检查,5例行 99Tcm-MDP全身骨扫描显像。对本组患者的皮质骨转移瘤灶的影像学表现进行分析,并分别依据Coerkamp and Greenspan等的分型标准进行分类。结果:14例患者中男性 10例,女性4例,年龄40岁-77岁,平均年龄59．2岁。单发骨转移瘤者5例,全身多发骨转移瘤者9例。共19处皮质骨转移瘤灶,其中股骨15处,胫骨3处,肱骨1处。17处皮质骨转移瘤灶位于骨干,其余2处位于股骨小转子。原发肿瘤包括肺癌、肝癌和食道癌,3例原发部位不明。11例患者以四肢长骨皮质骨转移瘤所产生的局部症状为其就诊的首要原因, 包括患侧肢体疼痛、局部触及肿块等,其原发肿瘤由入院后相关检查发现;3例患者因原发肿瘤术后局部症状前来就诊。 6处病灶表现为完全位于骨皮质内的溶骨性骨质破坏灶,13处病灶表现为主要累及骨皮质的偏心性溶骨性骨质破坏。12处病灶边界清晰;7处边界模糊。3处皮质骨转移瘤灶伴局部骨膜三角形成。7处病灶可见局部大小不等的软组织肿块形成。 MRI呈等T1高T2信号,脂肪抑制序列呈高信号,T1WI增强扫描病变可见强化。全身骨扫描表现为放射性异常浓聚,较小的皮质骨转移瘤灶无法一一识别。结论:四肢长骨皮质转移瘤为骨转移瘤的一种特殊表现,多发生于股骨干,原发肿瘤为肺癌者为多。病变处X线平片切线位投照及CT检查显示清晰。MRI在显示微小皮质骨转移瘤灶与病变范围的显示等方面较X线平片与CT更有优势。同位素全身骨扫描有助于全身其它部位骨转移瘤灶的检出,对其正确诊断有提示作用。鉴别诊断包括血管源性肿瘤、浆细胞瘤、甲状腺机能亢进的棕色瘤、骨膜下骨肉瘤、动脉瘤样骨囊肿、骨纤维发育不良、及原发性软组织肉瘤侵及骨等。对于发生于患者长骨皮质的病变尤其是老年患者或有原发肿瘤病史者,应考虑到骨转移瘤的诊断。更多还原

【Abstract】 Objective: To analyze the imaging findings of cortical metastasis of extremities, and to evaluate the value of imaging in the diagnosis of cortical metastasis of extremities. Methods: Clinical data and imaging findings in 14 patients of cortical metastasis of extremities were reviewed. All of them had conventional X-ray films, 10 cases had CT scanning, 4 cases had MR scanning, 5 cases had bone scintigraphy. Analyze the imaging findings of 19 cortical lesions, and distinguish them into four different types according to Coerkamp and Greenspan respectively. Results: In 5 cases, the cortical metastases were the only manifestation of tumor spread. In 9 cases, there were other skeletal lesions. There were 19 cortical lesions in 14 cases. Fifteen cortical lesions were located in the femur, 3 in the tibia, and 1 in humerus. The primary tumors involved were 9 lung carcinomas, 1 liver carcinoma, and 1 oesophagus carcinoma. In three cases, the primary tumor remained unknown. Cortical metastasis of extremities showed eccentric osteolytic destruction in X-ray and CT films, and the osseous involvement were predominantly cortical. In 13 cortical lesions, there were cortical destruction with extension into the soft tissue and/or the medulla. In 4 cases, MRI was useful in delineating the extent of tumor and soft tissues mass, as well as the extent of tumor in bone marrow. Cortical metastasis showed middle signal in T1WI, and high signal in T2WI. In 5 cases, cortical metastases showed abnormal focus in bone scintigraphy. Conclusion: Cortical bone metastases of extremities are uncommon. Femur is most likely to be involved. Metastatic osteolytic lesions predominantly involving the cortex of long bone are highly responsible for lung carcinomas. A metastatic ori- gin should be considered in the differential diagnosis of an osteolytic lesion arising in the cortex of a long bone, especially in older patients and/or patients with a known primary malignant carcinoma.更多还原