Oudenhoven L F I J, Dhondt E, Kahn S, Nieborg A, Kroon H M J, Hogendoorn P C W, Gielen J L, Bloem J L, De Schepper A
Department of Radiology, C2-S, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands.
Skeletal Radiol. 2006 Feb;35(2):78-87. doi: 10.1007/s00256-005-0023-y. Epub 2005 Oct 25.
To determine the usefulness of radiography and magnetic resonance imaging in differentiating benign from malignant bony tumors of the hand and in making a tissue-specific diagnosis.
Two hundred consecutive bony tumors of the hand, the details of which originated from a national databank, were studied in a prospective way by radiography (100%) and by MRI (25%). All tumors were graded on a five-point scale, from certainly benign to certainly malignant, using location and morphology as diagnostic parameters. For all tumors a tissue-specific diagnosis was made, by the proposal of three possibilities in decreasing order of probability. Histological diagnosis was made by peer review, according to the WHO classification.
By the combining of "certainly" and "probably" benign (grades I and II) and "certainly" and "probably" malignant (grades IV and V), a correct grading was obtained in 165 (82.5%) of the cases (154 of the 173 benign and 11 of the 27 malignant tumors). A correct tissue-specific diagnosis was included in the three proposed differentials in 87.5%. MRI confirmed a correct diagnosis made on radiography in 72% and improved the grading capability by correctly upgrading malignant tumors and downgrading benign tumors in, respectively, 8% and 12%. The capability to obtain a tissue-specific diagnosis improved with change of an incorrect diagnosis on radiography to a correct one on MRI in 12 cases (24%).
Subjective (semiquantitative) grading on radiography by an expert group proved to be excellent when compared with the results of a quantitative analysis of individual grading parameters. Multiple logistic regression analysis of these parameters resulted in a grading formula containing only six variables. The additional value of MRI in grading was amply demonstrated. Already high accuracy of radiography, in making a tissue-specific diagnosis, improved substantially after the performance of MRI.
确定X线摄影和磁共振成像在鉴别手部良性与恶性骨肿瘤以及进行组织特异性诊断方面的效用。
对200例连续的手部骨肿瘤进行前瞻性研究，这些病例细节源自一个国家数据库，所有病例均进行了X线摄影（100%）和MRI检查（25%）。以部位和形态作为诊断参数，所有肿瘤按五分制分级，从肯定良性到肯定恶性。针对所有肿瘤，按可能性从高到低提出三种可能性进行组织特异性诊断。组织学诊断由同行评审，依据世界卫生组织分类标准进行。
将“肯定”和“可能”良性（I级和II级）以及“肯定”和“可能”恶性（IV级和V级）合并后，165例（82.5%）病例获得了正确分级（173例良性肿瘤中的154例以及27例恶性肿瘤中的11例）。87.5%的病例在提出的三种鉴别诊断中包含了正确的组织特异性诊断。MRI证实X线摄影做出的正确诊断占72%，通过正确提升恶性肿瘤分级和降低良性肿瘤分级，分别在8%和12%的病例中提高了分级能力。在12例（24%）病例中，MRI将X线摄影的错误诊断转变为正确的组织特异性诊断，从而提高了诊断能力。
与对各个分级参数进行定量分析的结果相比，专家组对X线摄影进行的主观（半定量）分级结果极佳。对这些参数进行多元逻辑回归分析得出了一个仅包含六个变量的分级公式。充分证明了MRI在分级方面的附加价值。在进行MRI检查后，X线摄影在进行组织特异性诊断时本就较高的准确性有了显著提高。
