【摘要】 目的：为了提高对多发性骨髓瘤（ Ｍ Ｍ） 和骨转移瘤的影像学（ Ｘ 线、 Ｃ Ｔ） 的鉴别诊断水平。方法：收集经骨髓涂片或局部病灶活检病理证实的 Ｍ Ｍ４４ 例。经手术、病理证实原发肿瘤并骨质破坏者７１ 例；骨破坏灶穿刺病理为骨转移瘤５ 例。将上述两组病例的 Ｘ 线及 Ｃ Ｔ 表现进行回顾性分析对比。结果：颅骨病变发生率 Ｍ Ｍ 为８５ ％ ，骨转移瘤为２１４３ ％ ，两者比较 Ｐ＜ ０００５ ；下颌骨破坏 Ｍ Ｍ 为５０ ％ ，骨转移瘤为７１４ ％ ，两者比较 Ｐ＜ ００１ 。脊柱附件骨质破坏部位两病不同， Ｍ Ｍ 仅破坏椎弓，转移瘤不仅破坏椎弓，还破坏椎弓以外附件。膨胀性骨破坏的 Ｃ Ｔ 表现， Ｍ Ｍ 骨破坏部位为密度均匀边缘清楚的软组织影替代，残留骨壳排列规则，对邻近软组织仅为压迫性改变。骨转移瘤骨膨胀性改变轻，对邻近软组织为浸润性改变，在病变内见分布不规则高密度的斑点状残留骨或肿瘤骨。结论：颅骨破坏且为多发病灶及下颌骨破坏，对诊断 Ｍ Ｍ 有重要价值。脊椎骨质破坏灶累及椎弓及椎弓以外附件及病灶范围内见斑点状高密影者，首先考虑为骨转移瘤。更多还原

【Abstract】 Aim:To improve differential diagnosis by imaging(X-ray and CT) between multiple myeloma (MM) and metastatic tumor of bone.Methods:44 MM cases proved by pathological examination of bone marrow smear and focal lesion biopsy, and 71 cases of primary malignancy with osseous destruction as well as 5 cases of bony metastasis proved pathologically.Results:Incidence of cranial bone involvement in MM was 85.00% and that in osseous metastasis was 21.43%, P <0.005; 50 00% of MM versus 7 14% of osseous metastasis had mandibular destruction, P <0.01. The parts of vertebral appendix destruction of MM and bone metastasis were different: it occurred only in the pedicle in the former, while it occurred in other parts of the appendix besides the pedicle in the latter. In CT, expansive osseous destruction of MM appeared as a well-defined homogeneous soft tissue density with regular bony shell, and the expansive lesion only pressed contiguous structure, while the expansive osseous destruction in metastasis was mild with irregular mottled hyperdense residual or tumor bone within it ,and the expansive lesion invaded contiguous structure. Conclusion:Cranial bone destruction with multiple lesions and mandibular destruction are valuable signs for diagnosing MM. Vertebral destructive lesion involving pedicle and other parts of appendix besides pedicle and mottled hyperdensity within destructive lesion is in favor of diagnosing osseous metastasis.更多还原