Sundaram M, McLeod R A
Department of Radiology, St. Louis University Medical Center, MO 63110-0250.
AJR Am J Roentgenol. 1990 Oct;155(4):817-24. doi: 10.2214/ajr.155.4.2119115.
This review examines the role of MR imaging in the diagnosis and staging of tumors and tumorlike lesions of bone and soft tissue. For tumors of bone, the plain radiograph is not only the least expensive diagnostic test but is the most reliable predictor of the histologic nature of a given lesion. Consequently, it should be the first procedure performed and serve as the basis for determining the next step in the patient's evaluation. MR imaging is the examination of choice for staging bone tumors. CT is preferred to MR imaging only when the characteristics of the lesion are inadequately defined on plain radiographs, as may occur in flat bones. Although MR imaging is of limited value in predicting the histology of bone tumors, it is a useful tool for distinguishing round-cell tumors and metastases from stress fractures and medullary infarcts in symptomatic patients with normal radiographs. For depiction of soft-tissue masses, MR imaging is unrivaled. The histologic nature of a soft-tissue mass may, in some instances, be predicted on the basis of its MR appearance and multicentricity. Biopsy of bone and soft-tissue tumors should follow and not precede MR imaging. MR imaging reliably shows change in tumor volume after radiation or chemotherapy. It is less reliable in predicting the amount of tumor necrosis.
本综述探讨了磁共振成像（MR成像）在骨与软组织肿瘤及肿瘤样病变的诊断和分期中的作用。对于骨肿瘤，X线平片不仅是最便宜的诊断检查，而且是给定病变组织学性质最可靠的预测指标。因此，它应是首先进行的检查，并作为确定患者下一步评估步骤的基础。MR成像是骨肿瘤分期的首选检查。仅当病变特征在X线平片上显示不清时，如在扁骨中可能出现的情况，CT才优于MR成像。虽然MR成像在预测骨肿瘤的组织学方面价值有限，但对于有症状且X线平片正常的患者，它是区分圆形细胞瘤和转移瘤与应力性骨折及骨髓梗死的有用工具。对于软组织肿块的显示，MR成像无与伦比。在某些情况下，软组织肿块的组织学性质可根据其MR表现和多中心性来预测。骨与软组织肿瘤的活检应在MR成像之后而非之前进行。MR成像能可靠地显示放疗或化疗后肿瘤体积的变化。在预测肿瘤坏死量方面则不太可靠。
