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目的探讨肢体骨肉瘤新辅助化疗前后髓腔MRI T_1像上信号的变化。方法回顾研究58例肢体骨肉瘤,将新辅助化疗前后髓腔的MRI T_1像进行对比,记录化疗前患者的MRI T_1像肿瘤与正常髓腔是否有清晰边界,化疗后分界是否仍清晰,不清晰出现的比例及信号变化。部分患者进行了双侧肢体MRI检查,对比双侧MRI信号的异同。获得瘤段截除标本后,对化疗后出现信号改变的部位进行病理取材,研究这种信号改变的组织学构成。结果髓腔MRI T_1信号形态可分为清晰、连续弥漫、间断岛状、间断弥漫4种,58例患者入院MRI上均为清晰的髓腔分界。化疗后MRI边界清晰22例,占37.9%,36例为化疗前MRI清晰而化疗后变为不清晰,占62.1%。其中连续弥漫20例,占34.5%;间断岛状4例,占6.9%;间断弥漫12例,占20.7%。9例化疗后MRI可显示双侧股骨,健侧股骨髓腔内也出现了与患侧股骨类似的斑片状弥漫信号。对33例MRI T_1加权像上显示异常的区域进行取材,组织学显示为增生的骨髓造血细胞,无肿瘤细胞。结论新辅助化疗前后MR/T_1像上显示的骨肉瘤髓内异常信号范围可发生变化,部分患者在新辅助化疗后出现瘤旁异常信号,对于这些肿瘤外的、形态上呈岛状及弥漫斑片状的异常信号,如在MRI T_1像上较脂肪信号低,较骨骼肌信号高,临床上要考虑到有可能发生了骨髓逆转换,是骨髓的正常变化,不能将这种增生骨髓误认为肿瘤的进展而造成截骨长度的增加。
Objective To investigate the signal changes of MRI T_1 in the medullary cavity before and after neoadjuvant chemotherapy for limb osteosarcoma. Methods A total of 58 cases of limb osteosarcoma were retrospectively studied. MRI T_1 images of the medullary cavity before and after neoadjuvant chemotherapy were compared. MRI T_1 imaging before treatment was used to record whether the tumor had a clear border with the normal marrow cavity. The ratio of occurrence and signal change. Some patients had bilateral limb MRI examination, comparing the similarities and differences of bilateral MRI signals. Obtained tumor segment excised specimens, pathological changes of the signal after the emergence of parts of the study to study the histological changes in signal structure. Results MRI T 1 signal morphology in the medullary cavity can be divided into clear, continuous diffuse, intermittent islands, intermittent diffuse four kinds of 58 patients were admitted to the MRI were clear on the marrow cavity boundaries. After the chemotherapy, the borderline of MRI was clear in 22 cases, accounting for 37.9%. Thirty-six cases had clear MRI before chemotherapy and were not clear after chemotherapy, accounting for 62.1%. Among them, 20 cases were continuously infiltrated, accounting for 34.5%; 4 cases were discontinuous island, accounting for 6.9%; intermittent diffuse 12 cases, accounting for 20.7%. 9 cases of post-chemotherapy MRI can show bilateral femur, contralateral femoral medullary cavity similar to the ipsilateral femur patchy diffuse signal. 33 cases of MRI T 1 weighted image showed abnormalities in the region were drawn histological proliferation of bone marrow hematopoietic cells without tumor cells. Conclusion Before and after neoadjuvant chemotherapy, the intraosseous abnormal signal of osteosarcoma may be changed on the MR / T 1 image. Some patients have abnormal signal of tumor beside neoadjuvant chemotherapy. For these tumors, there are morphologically island-like and diffuse Flaky abnormal signals, such as MRI T_1 image lower than the fat signal, compared with skeletal muscle signal, clinically to take into account the possible occurrence of bone marrow inverse conversion is a normal change in the bone marrow can not be mistaken for this proliferation of bone marrow The progress of the tumor results in an increase in the length of the osteotomy.