Wagh Yash, Reddy Rajeev, Gundavda Manit, Agarwal Manish, Agashe Vikas M, Bajwa Supreet
Department of Orthopedics, P D Hinduja Hospital and Medical Research Centre, Mahim, Mumbai 400016, India.
Department of Orthopedics, P D Hinduja Hospital and Medical Research Centre, Mahim, Mumbai 400016, India - Dr Agashe's Maternity and Surgical Nursing Home, Kurla, Mumbai 400070, India.
SICOT J. 2020;6:14. doi: 10.1051/sicotj/2020011. Epub 2020 May 28.
To highlight radiological features and emphasize the need for tissue diagnoses to confirm bone pathology. Tuberculosis is known to present without constitutional symptoms and with unconventional imaging features mimicking sarcomas as shown in our series of 25 patients; where the imaging and biopsy protocols at our institute helped to solve these diagnostic dilemmas.
We retrospectively analyzed clinical and radiological features and tissue diagnoses in 25 patients referred to the department of orthopedic oncology with radiological suspicion of tumor.
Only 7 patients had cultures positive for Mycobacterium Tuberculosis T.B. Radiological features suggestive of infection were Metaphyseal and joint involvement, permeative lesions, absence of Codman's triangle, and soft tissue mass suggestive of a cold abscess. The predictive accuracy of the orthopedic oncologist was 60% and musculoskeletal radiologist was 72% (based on radiology). Final diagnosis is 100% confirmed on histopathology.
Diagnosis based primarily upon imaging is a wrong approach. A multimodal approach to differentiating tuberculous bone infections from sarcomas is essential.
强调放射学特征，并强调需要进行组织诊断以确诊骨病变。众所周知，结核病可无全身症状，且具有模仿肉瘤的非典型影像学特征，如我们对25例患者的系列研究所示；我们研究所的影像学和活检方案有助于解决这些诊断难题。
我们回顾性分析了25例因影像学怀疑肿瘤而转诊至骨肿瘤科的患者的临床、放射学特征及组织诊断结果。
仅7例患者结核分枝杆菌培养呈阳性。提示感染的放射学特征包括干骺端及关节受累、浸润性病变、无科德曼三角以及提示寒性脓肿的软组织肿块。骨肿瘤医生的预测准确率为60%，肌肉骨骼放射科医生的预测准确率为72%（基于放射学）。最终诊断经组织病理学100%确诊。
主要基于影像学进行诊断是错误的方法。采用多模式方法区分结核性骨感染和肉瘤至关重要。
