Chang Connie, Chebib Ivan, Torriani Martin, Bredella Miriam
Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
Skeletal Radiol. 2017 Mar;46(3):351-358. doi: 10.1007/s00256-016-2566-5. Epub 2017 Jan 7.
To describe the imaging and clinical characteristics of chordoma osseous metastases (COM).
Our study was IRB approved and HIPAA compliant. A retrospective search of our pathology database for pathology-proven COM yielded 15 patients who had undergone MRI, CT, bone scan, and/or FDG-PET/CT. The imaging and clinical features of the COMs were recorded. A control group of age and gender matched chordoma patients without osseous metastasis was evaluated.
The COM mean maximal dimension was 6.4 ± 4.0 cm. The majority (60%) of patients had one lesion. Extra-osseous soft tissue component was present in 85% and was larger than intra-osseous component in 76%. On MRI the lesions were heterogeneous but predominantly T2 hyperintense with hypointense septae, and with variable enhancement. On CT the lesions were typically destructive or permeative; calcifications were rare. The extent of the soft tissue component was isodense to muscle on CT and therefore better evaluated on MRI. COM was in a body part contiguous to the site of the primary tumor. Compared to the controls, COM patients were more likely to have local recurrence (P = 0.0009) and positive resection margins (P = 0.002). At 1 year, 33% of COM patients were deceased and 13% had progressive metastases.
COM are associated with large extra-osseous soft tissue components, which are better visualized by MRI. They are often located in a body part contiguous to the site of the primary tumor, portend poor prognosis, and are associated with positive resection margins and local recurrence.
描述骨转移性脊索瘤（COM）的影像学和临床特征。
本研究经机构审查委员会（IRB）批准并符合健康保险流通与责任法案（HIPAA）规定。对我们的病理数据库进行回顾性检索，以查找经病理证实的COM患者，共纳入15例接受过MRI、CT、骨扫描和/或FDG-PET/CT检查的患者。记录COM的影像学和临床特征。对一组年龄和性别匹配的无骨转移的脊索瘤患者作为对照组进行评估。
COM的平均最大径为6.4±4.0 cm。大多数（60%）患者有一个病灶。85%的患者存在骨外软组织成分，其中76%的患者骨外软组织成分大于骨内成分。在MRI上，病灶表现为不均匀信号，但主要为T2高信号，伴有低信号分隔，增强方式多样。在CT上，病灶通常表现为破坏性或浸润性；钙化少见。软组织成分在CT上与肌肉密度相等，因此在MRI上能更好地评估。COM位于与原发肿瘤部位相邻的身体部位。与对照组相比，COM患者更易出现局部复发（P = 0.0009）和手术切缘阳性（P = 0.002）。1年时，33%的COM患者死亡，13%有进行性转移。
COM与较大的骨外软组织成分相关，MRI能更好地显示这些成分。它们常位于与原发肿瘤部位相邻的身体部位，预后不良，且与手术切缘阳性和局部复发相关。
