成软骨细胞性骨肉瘤与软骨肉瘤的异同特征：X线摄影及磁共振成像要点

Different and identical features of chondroblastic osteosarcoma and chondrosarcoma: highlights on radiography and magnetic resonance imaging.

作者信息

Yen Chao-Hsuan, Chang Cheng-Yen, Teng Michael Mu-Huo, Wu Hung-Ta H, Chen Paul Chih-Hsueh, Chiou Hong-Jen, Chiu Nai-Chi

机构信息

Department of Radiology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.

出版信息

J Chin Med Assoc. 2009 Feb;72(2):76-82. doi: 10.1016/S1726-4901(09)70027-9.

DOI:10.1016/S1726-4901(09)70027-9

PMID:19251535

Abstract

BACKGROUND

To identify the different and identical features of 2 tumors with similar pathologic findings, chondroblastic osteosarcoma (OGS) and chondrosarcoma (CSA), with highlights on radiography and magnetic resonance imaging (MRI).

METHODS

Ten patients with chondroblastic OGS and 10 patients with CSA were enrolled. After recording the tumor location, tumor morphology was evaluated for patterns of bony destruction, visible tumor matrix, and aggressive periosteal reactions, endosteal scalloping, cortical expansion, cortical breakthrough and pathologic fracture by radiographic analysis. Signal intensity changes, enhancement pattern, and tumor extensions were evaluated by MRI.

RESULTS

The mean patient ages were 24.7 and 56.7 years in patients with chondroblastic OGS and CSA, respectively (p = 0.001). Tumor occurrence was detected in the appendicular bones in 8 chondroblastic OGS and 3 CSA. Three chondroblastic OGS occurred around the knee (p = 0.003). In addition, there were 6 tumors arising from the metaphysis and 2 arising from the diaphysis in chondroblastic OGS patients. In CSA patients, 1 tumor arose in the metaphysis, 1 in the diaphysis, and 1 in the epiphysis (p = 0.039). On radiographs, visible bone-forming tumor matrix was present in 8 chondroblastic OGS, and coexistence of bone- and cartilage-forming patterns were detected in 2. Visible cartilage-forming tumor matrix was present in 7 CSA, and atypical radiodensity patterns were detected in 2 (p < 0.001). Aggressive periosteal reaction was present in 7 chondroblastic OGS, and non-aggressive periosteal reaction was found in 1 CSA (p = 0.008). MRI revealed the presence of a lobular structure of high signal intensity on T2-weighted images, and peripheral rim and septal enhancement pattern was noted in 2 chondroblastic OGS and 10 CSA patients. Inhomogeneous and marginal enhancement patterns were noted in 6 and 2 chondroblastic OGS, respectively (p = 0.001).

CONCLUSION

Metaphysis origin, bone-forming tumor matrix, aggressive periosteal reaction, and young patient age favored chondroblastic OGS. Some chondroblastic OGS showed radiologic and MRI appearances that were typical of CSA.

摘要

背景

为鉴别具有相似病理表现的两种肿瘤——成软骨细胞性骨肉瘤（OGS）和软骨肉瘤（CSA）的异同点，并重点关注X线摄影和磁共振成像（MRI）表现。

方法

纳入10例成软骨细胞性OGS患者和10例CSA患者。记录肿瘤位置后，通过X线分析评估肿瘤形态，包括骨破坏模式、可见肿瘤基质、侵袭性骨膜反应、骨内膜扇贝样改变、皮质膨胀、皮质突破和病理性骨折。通过MRI评估信号强度变化、强化模式和肿瘤范围。

结果

成软骨细胞性OGS患者和CSA患者的平均年龄分别为24.7岁和56.7岁（p = 0.001）。8例成软骨细胞性OGS和3例CSA发生于四肢骨。3例成软骨细胞性OGS发生于膝关节周围（p = 0.003）。此外，成软骨细胞性OGS患者中6例肿瘤起源于干骺端，2例起源于骨干。在CSA患者中，1例肿瘤起源于干骺端，1例起源于骨干，1例起源于骨骺（p = 0.039）。X线片上，8例成软骨细胞性OGS可见骨形成性肿瘤基质，2例可见骨和软骨形成模式并存。7例CSA可见软骨形成性肿瘤基质，2例可见非典型放射密度模式（p < 0.001）。7例成软骨细胞性OGS可见侵袭性骨膜反应，1例CSA可见非侵袭性骨膜反应（p = 0.008）。MRI显示在T2加权图像上存在高信号强度的小叶结构，2例成软骨细胞性OGS和10例CSA患者可见周边边缘和间隔强化模式。6例和2例成软骨细胞性OGS分别可见不均匀强化和边缘强化模式（p = 0.001）。