Itoh K
Department of Orthopedic Surgery, Tokyo Medical College, Japan.
Nihon Seikeigeka Gakkai Zasshi. 1995 Oct;69(10):899-914.
Diagnostic methodology for bone and soft tissue tumors has made great strides recently through the development of magnetic resonance imaging (MRI). Here we report a comparative assessment of the histological findings of bone and soft tissue tumors with MRI from 212 cases. The accuracy of a qualitative diagnosis was observed in a solitary bone cyst, enchondroma, giant cell tumor, chondrosarcoma, lipoma, hemangioma, neurinoma, and in a synovial cyst. However, the qualitative diagnosis of a malignant tumor was difficult because of the variety of the intratumoral histological changes. An enhanced-image using Gd-DTPA was useful for differentiation of the viable region in the internal area of a tumor, discrimination of the rective zone of an edema or assessing vascularity, and for discrimination between a cyst and a solid tumor. Based on comparison with findings from the excised specimen, it was found that histological changes such as calcification, fibrosis, hemorrhaging and necrosis, and the presence or absence of a tumor capsule had been reflected accurately on MR images. However, infiltration of the tumor into the bone cortex and into the articular cartilage were found frequently to be false-positive on MRI. Although problems remained to be solved regarding the evaluation of the presence or absence of tumor infiltration into adjacent tissue, the depiction of periosteal reaction, and regarding differentiation from inflammatory disease, MRI was a very useful information source for operative planning because it could evaluate the relationship between the tumor and adjacent blood vessels or nerves, the effect of preoperative therapy, and effectively discriminate between benign and malignant tumors.
近年来,通过磁共振成像(MRI)技术的发展,骨与软组织肿瘤的诊断方法取得了巨大进步。在此,我们报告了对212例骨与软组织肿瘤的MRI检查结果与组织学检查结果的对比评估。在孤立性骨囊肿、内生软骨瘤、骨巨细胞瘤、软骨肉瘤、脂肪瘤、血管瘤、神经鞘瘤及滑膜囊肿中观察到定性诊断的准确性。然而,由于肿瘤内部组织学变化的多样性,恶性肿瘤的定性诊断较为困难。使用钆喷酸葡胺(Gd-DTPA)增强成像有助于区分肿瘤内部的活性区域、辨别水肿的反应区或评估血管情况,以及区分囊肿与实性肿瘤。通过与切除标本的检查结果进行对比发现,诸如钙化、纤维化、出血和坏死等组织学变化以及肿瘤包膜的有无在MR图像上均得到了准确反映。然而,发现肿瘤向骨皮质和关节软骨的浸润在MRI上经常出现假阳性。尽管在评估肿瘤是否浸润至邻近组织、骨膜反应的显示以及与炎性疾病的鉴别等方面仍存在有待解决的问题,但MRI对于手术规划而言是一个非常有用的信息来源,因为它能够评估肿瘤与邻近血管或神经的关系、术前治疗的效果,并有效区分良性和恶性肿瘤。