Tanutit Pramot, Pakdee Wisitsak, Laohawiriyakamol Teeranan, Iamthanaporn Khanin
Department of Radiology, Faculty of Medicine, 26686Prince of Songkla University, Songkhla, Thailand.
Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, 26686Prince of Songkla University, Songkhla, Thailand.
Acta Radiol. 2023 Feb;64(2):625-637. doi: 10.1177/02841851221082098. Epub 2022 Mar 21.
While radiography remains essential in the initial evaluation of bone lesions, tissue biopsy or further imaging is often required to clarify indeterminate radiographic features. Magnetic resonance imaging (MRI) assists radiologists in evaluating lesions with indeterminate features as it has advantages in delineating tumorous tissues and bone marrow.
To evaluate the association factors of MRI for bony aggressiveness.
A retrospective analysis of 226 MRI examinations from patients diagnosed with bone tumors in a tertiary hospital during 2008-2018 was performed. All the MR images were interpreted by musculoskeletal radiologists without diagnostic information. The bony lesions were categorized into aggressive and non-aggressive groups using tumor margin, cortical changes, periosteal reaction, joint extension, extraosseous soft tissue involvement, tumor homogeneity, and enhancement pattern from the MR images. Univariable and multivariable analysis were applied for each feature on the MRI scans. In addition, sensitivity and specificity were calculated for MRI diagnoses of aggressive bone lesions.
In total, 180 aggressive and 46 non-aggressive bone lesions were examined on MRI. The sensitivity and specificity of MRI for differentiating between aggressive and non-aggressive bone lesions were 98.89% and 50%, respectively. Ill-defined margin, cortical break, cortical signal changes, sunburst and Codman's triangle periosteal reaction, joint extension, and tumoral and heterogeneous enhancement could be predictive signs for aggressive bone lesions.
MRI can be a valuable tool to assist in distinguishing aggressive from non-aggressive bone lesions. In cases of indeterminate radiographic features, MRI could be used as an additional imaging to improve diagnostic accuracy and could reduce unnecessary invasive procedures.
虽然X线摄影在骨病变的初始评估中仍然至关重要，但通常需要组织活检或进一步的影像学检查来明确不确定的X线特征。磁共振成像（MRI）有助于放射科医生评估具有不确定特征的病变，因为它在描绘肿瘤组织和骨髓方面具有优势。
评估MRI显示骨侵袭性的相关因素。
对2008年至2018年期间在一家三级医院诊断为骨肿瘤的患者的226例MRI检查进行回顾性分析。所有MR图像均由肌肉骨骼放射科医生解读，且无诊断信息。根据MR图像上的肿瘤边缘、皮质改变、骨膜反应、关节受累、骨外软组织受累、肿瘤同质性和强化方式，将骨病变分为侵袭性和非侵袭性组。对MRI扫描的每个特征进行单变量和多变量分析。此外，计算MRI诊断侵袭性骨病变的敏感性和特异性。
总共对180例侵袭性骨病变和46例非侵袭性骨病变进行了MRI检查。MRI区分侵袭性和非侵袭性骨病变的敏感性和特异性分别为98.89%和50%。边界不清、皮质中断、皮质信号改变、日光放射状和科德曼三角骨膜反应、关节受累以及肿瘤性和不均匀强化可能是侵袭性骨病变的预测征象。
MRI可以作为辅助区分侵袭性和非侵袭性骨病变的有价值工具。在X线特征不确定的情况下，MRI可作为额外的影像学检查以提高诊断准确性，并可减少不必要的侵入性操作。
