Kitajima Kazuhiro, Futani Hiroyuki, Fujiwara Masayuki, Minakawa Go, Osugi Yuko, Tsuchitani Tatsuya, Yamakado Koichiro
Radiology, Hyogo College of Medicine, Nishinomiya, JPN.
Orthopaedics, Hyogo College of Medicine, Nishinomiya, JPN.
Cureus. 2018 Nov 28;10(11):e3655. doi: 10.7759/cureus.3655.
We report here a case of periosteal sarcoma in a 10-year-old female, along with quantitative values obtained with bone single photon emission computed tomography/computed tomography (SPECT/CT), which were useful to evaluate treatment response to preoperative chemotherapy. Pretreatment radiograph images of the lower leg showed cortical thickening eroded by a broad-based soft-tissue mass without the involvement of the underlying cortex, while computed tomography (CT) revealed a small juxtacortical mass with thick calcification and periosteal reaction. In magnetic resonance imaging (MRI), the mass showed hypointensity in the inner part and isointensity in the outer part in T1-weighted images, while the inner part showed hypointensity and the outer part hyperintensity in T2-weighted images. Bone SPECT/CT results indicated the focal and intense uptake of the mass. Following neoadjuvant chemotherapy (NAC), radiograph and MRI results revealed a slight increase in size, with growing calcification. Although visual inspection of the bone SPECT/CT findings showed nearly the same amount of focal uptake, quantitative parameters determined with those findings were decreased, with maximum standardized uptake value (SUV), peak SUV, mean SUV, metabolic bone volume (MBV), and total bone uptake (TBU) reduced by -20.7%, -22.0%, -12.6%, -33.5%, and -41.9%, respectively. The excision biopsy at the surgery showed a pathological grade 1 (non-complete response) after NAC, including a more than 20% of cell necrosis part. The quantitative bone SPECT/CT was considered to reflect treatment response in this case.
我们在此报告一例10岁女性的骨膜肉瘤病例，以及通过骨单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）获得的定量值，这些值有助于评估术前化疗的治疗反应。小腿的治疗前X线片图像显示皮质增厚，被一个基底较宽的软组织肿块侵蚀，下方皮质未受累，而计算机断层扫描（CT）显示一个小的皮质旁肿块，伴有厚钙化和骨膜反应。在磁共振成像（MRI）中，肿块在T1加权图像中内部呈低信号，外部呈等信号，而在T2加权图像中内部呈低信号，外部呈高信号。骨SPECT/CT结果显示肿块有局灶性且强烈的摄取。新辅助化疗（NAC）后，X线片和MRI结果显示肿块大小略有增加，钙化增多。尽管肉眼观察骨SPECT/CT结果显示局灶性摄取量几乎相同，但根据这些结果确定的定量参数有所下降，最大标准化摄取值（SUV）峰值、SUV峰值、平均SUV、代谢骨体积（MBV）和总骨摄取量（TBU）分别降低了-20.7%、-22.0%、-12.6%、-33.5%和-41.9%。手术切除活检显示NAC后病理分级为1级（非完全缓解），包括超过20%的细胞坏死部分。在该病例中，定量骨SPECT/CT被认为反映了治疗反应。
