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目的提高骨巨细胞瘤(GCT)继发动脉瘤样骨囊肿(ABC)的认识和影像诊断水平。方法搜集经手术病理证实的12例 GCT 继发 ABC 的 X 线、CT、MRI 和病理学资料,分析和总结其影像征象。结果 12例中6例病变发生于长管状骨,6例发生于盆骨。12例病变 X 线均表现为囊状膨胀性溶骨性骨破坏,10例呈偏心性破坏,2例为中心性破坏;4例病灶内出现骨性分隔,6例骨皮质中断,4例出现软组织肿块,有明显硬化边者2例。10例行 MR 平扫和增强检查,均呈多囊的囊实性膨胀性肿块,8例为边缘性实性结节,2例为实性基础上的广泛囊变,全部患者均可见多个液-液平面,7例出现软组织肿块;1例肿块内可见局灶性含铁血黄素沉着。8例行螺旋 CT 平扫、增强、CT 血管成像(CTA)和三维(3D)多平面重组(MPR),病变显示为囊实性肿块,骨皮质破裂并形成软组织肿块5例,6例肿块内出现液-液平面,全部肿块实质性部分和囊壁明显强化,囊性部分不强化,3例肿块内可见增粗迂曲的供血动脉,未发现动静脉畸形。12例手术所见和术后病理显示肿块均由多发含血的囊腔和实性部分组成,病理诊断结果均为 GCT 伴发 ABC,其中Ⅱ级 GCT 10例,Ⅲ级2例。结论 GCT伴发 ABC 并不少见,充分理解其病理组织学基础,并选择恰当的影像检查方法(X 线+MRI 或 X 线+CT)对其正确诊断非常重要。
Objective To improve the recognition and imaging diagnosis of secondary aneurysmal bone cysts (GCA) in giant cell tumor of bone (GCT). Methods X-ray, CT, MRI and pathology data of 12 cases with GCT confirmed by pathology were collected to analyze and summarize their imaging signs. Results Six of the 12 lesions occurred in long tubular bone and 6 in pelvic bone. Twelve cases of X-ray showed cystic expansion of osteolytic bone destruction, 10 cases of eccentric destruction, 2 cases of central damage; 4 cases of bony septal segmental, 6 cases of cortical disruption, 4 cases Soft tissue mass, with significant hardening of the edge in 2 cases. 10 cases of MR plain scan and enhanced examination, were cystic solid expansive mass, 8 cases of borderline solid nodules, 2 cases based on solid extensive cystic degeneration, all patients were seen more than one In the liquid-liquid level, soft tissue mass appeared in 7 cases and focal hemosiderin was seen in 1 mass. 8 cases of spiral CT scan, enhanced CT angiography (CTA) and three-dimensional (3D) multiplanar reconstruction (MPR), lesions showed cystic mass, cortical bone rupture and the formation of soft tissue mass in 5 cases, 6 cases of mass The liquid-liquid surface appeared. The substantive part of the mass and the cyst wall were obviously strengthened. The cystic part was not strengthened. The thicker and tortuous blood supply artery was seen in 3 cases, and no arteriovenous malformation was found. 12 cases of surgical findings and postoperative pathology showed that the mass was composed of multiple cysts and blood-containing cysts and solid parts, the pathological diagnosis of GCT associated with ABC, including 10 cases of grade Ⅱ GCT, grade Ⅲ in 2 cases. Conclusions GCT is not uncommon with ABC. It is very important to fully understand the histopathological basis of GCT and choose the appropriate imaging method (X - ray + MRI or X - ray + CT).