肿瘤源性骨软化症责任肿瘤的CT和MRI表现

发布时间：2018-02-03 15:09

本文关键词： 低磷骨软化肿瘤源性骨软化症磷酸盐尿性间叶性肿瘤 CT MRI　出处：《临床放射学杂志》2017年08期 　论文类型：期刊论文

【摘要】：目的探讨肿瘤源性骨软化症(TIO)责任肿瘤的CT和MRI表现,以提高对此疾病的诊断水平。方法回顾性分析经临床、实验室检查、影像学及病理学确诊的23例TIO患者的影像及临床资料。结果 23例TIO患者,男18例,女5例,年龄17~61岁,中位年龄39.0岁,病程1~11年,平均4.4年;病变最大径0.6~8.0 cm,平均2.8 cm;病变发生于股骨头5例,股骨颈3例,股骨下段3例,腓骨2例,下颌骨2例,上颌骨1例,颧弓1例,筛窦2例,鼻腔1例,坐骨直肠窝1例,膝关节内侧软组织1例,L5水平椎管内1例。21例有手术病理结果,其中16例诊断为磷酸盐尿性间叶肿瘤(1例为低度恶性,其余均为良性),5例因未做免疫组织化学检测仅诊断为梭形细胞肿瘤。11例行CT扫描,病变大部分密度均匀,部分有斑点状钙化,2例病变含有脂肪密度,所有病例未见明显出血、坏死及囊变;CT值-16~107 HU,平均为41.0 HU,仅1例增强CT表现为明显均匀强化;骨内及颌面部病变边界清晰,软组织内病变边界模糊,骨皮质旁病变共8例,其中7例可见邻近骨皮质破坏。19例行MRI扫描,病变在T_1WI上均为低信号,软组织内病变T_2WI上为高信号,骨内及骨皮质旁病变T_2WI抑脂像上为高信号、低信号或高低混杂信号,钆对比剂(Gd-DTPA)增强均表现为明显强化。结论由于TIO肿瘤病理组织形态上的多样性,决定了其影像学表现有较大差异,仅依靠影像学定性诊断非常困难。但是CT和MRI均可发现及清晰显示病变,对于已经排除其他病因并且无家族史的成年低磷骨软化患者,CT和MRI的异常影像学发现可以做出提示性诊断,也可以用于TIO确诊者的术前评估和治疗随访。
[Abstract]:Objective to investigate the CT and MRI findings of tumor-derived osteomalacia (Tlio) responsible tumors in order to improve the diagnostic level. Methods Clinical and laboratory examinations were retrospectively analyzed. Results the imaging and clinical data of 23 patients with TIO were confirmed by imaging and pathology. Results there were 23 patients with TIO, including 18 males and 5 females, with a median age of 39.0 years. The course of disease ranged from 1 to 11 years with an average of 4.4 years. The maximum diameter of lesion was 0.6 ~ 8.0 cm (mean 2.8 cm). The lesions occurred in 5 cases of femoral head, 3 cases of femoral neck, 3 cases of distal femur, 2 cases of fibula, 2 cases of mandible, 1 case of maxilla, 1 case of zygomatic arch, 2 cases of ethmoid sinus, 1 case of nasal cavity and 1 case of ischiorectal fossa. The medial soft tissue of knee joint was found in 1 case with L5 level in 1 case. 21 cases had surgical and pathological results. Among them, 16 cases were diagnosed as phosphate urinary mesenchymal tumor, 1 case was low grade malignant, and the rest was benign). Ct scan was performed in 5 cases only diagnosed as spindle cell tumor by immunohistochemistry. Most of the lesions were homogeneous, and 2 cases had partial spot calcification. The fat density was found in 2 cases. No obvious bleeding, necrosis and cysts were found in all cases. The CT value was -16 ~ 107HU, with an average of 41.0 HU.Only one case showed obvious homogeneous enhancement on enhanced CT. The boundary of intraosseous and maxillofacial lesions was clear, the margin of soft tissue lesions was blurred, and 8 cases had paracortical lesions. Among them, 7 cases were found to be damaged by adjacent bone cortex. 19 cases were scanned by MRI. The lesions were hypointensity on T _ 1WI, hyperintensity on T _ ti2WI in soft tissue lesions, hyperintensity on T _ 2WI in intraosseous and paracortical lesions, low signal intensity or high / low mixed signal on T _ 2WI. Gadolinium contrast agent Gd-DTPA showed obvious enhancement. Conclusion the imaging findings of TIO tumors are different due to the diversity of their histopathology. It is very difficult to rely on imaging qualitative diagnosis alone, but CT and MRI can both detect and clearly show the lesions, for adult patients with hypophosphoosteomalacia who have excluded other causes and have no family history. The abnormal imaging findings of CT and MRI can be used to make prompt diagnosis, preoperative evaluation and treatment follow-up of patients diagnosed with TIO.
【作者单位】：蚌埠医学院第一附属医院放射科;中国医学科学院北京协和医院放射科;浙江省宁波市第六医院;
【分类号】：R445.2;R730.44
【正文快照】： 肿瘤源性骨软化症(tumor induced osteomalacia,8 cm;病变部位股骨头5例,股骨颈3例,股骨下段3TIO)是一种副肿瘤综合征[1],该疾病是由于肿瘤通例,腓骨2例,下颌骨2例,上颌骨1例,颧弓1例,过分泌成纤维细胞生长因子(FGF-23)来影响肾脏筛窦2例,鼻腔1例,L5水平椎管内1例,右膝内侧对

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