软骨母细胞瘤X线、CT和MRI诊断

X-Ray, CT and MRI Diagnosis of Chondroblastoma

摘要: 背景：探讨软骨母细胞瘤(CBT)X线、CT与MRI的表现特征与诊断意义。方法：观察60例61个CBT瘤体的DR、CT与MRI表现，根据CT、MRI上CBT的几何中心判断其起始位置与侵犯模式；比较CT与MRI在检测瘤体结构、边界形态特征和瘤周骨内外反应等方面的差异；根据瘤灶的边缘与轮廓，将CBT分为5型：1型，多分叶单结节；2型，无分叶单结节；3型，梭形结节；4型，融合性多结节；5型，非结节状无定形。结果：52个长骨CBT，源于骨骺松质骨39个，其中27个破坏骺板及干骺端，12个完全位于骨骺；干骺端松质骨11个，其中10个侵及骺板及骨骺，1个局限于干骺端；起自干骺端骨皮质2个，其中1个侵入骨骺。9个不规则骨CBT中，8个偏心生长。DR、CT对瘤内钙化、硬化边和骨膜反应检出率分别为54.1% (33/61)，73.8% (45/61)，32.8% (20/61)；81.5% (44/54)，66.7% (36/54)，31.5% (17/54)。瘤内液平、骨膜反应检出率，MRI高于CT (X² = 10.44, P < 0.01; X² = 12.19, P < 0.01)；轮廓光整、边缘硬化、瘤内钙化、骨质穿破、骨髓反应、软组织肿块和关节反应检出率，二者差异无显著性。瘤体分型：1型，19个；2型，26个；3型，5个；4型，4个；5型，7个。结论：轮廓光整、边缘硬化的钙化结节，是CBT的特征性影像学表现。瘤体的5型分类与瘤周反应，丰富了对CBT的影像学认识。

Abstract: Background: To assess the manifestation characteristic of chondroblastom (CBT) in X-ray, CT and MRI images. Methods: The manifestations were reviewed of 61 tumoral masses in 60 patients with CBT in X-ray, CT and MRI images. The tumoral origin in bone and therefore tumoral invasional mode were determined based upon the geometric center provided by the CT and MRI images. The displaying rates between CT and MRI were compared in the respects of tumoral mass textures, mass borderline features and peritumoral reactions both in bone and in soft tissues. Based on the margins and contours of tumoral masses, the CBTs were categorized into 5 types: type 1, single multi-lobation node; type 2, single node with no lobation; type 3, fusiform node; type 4, confluent multiple nodes; type 5, amorphism with no nodar configuration. Results: Fifty-two CBTs were detected in long tubular bones, 39 of which originated from the epiphyses with 27 invading epiphyseal plates and metaphyses and 12 being confined in epiphses, 11 from metaphyses with 10 invading epiphyseal plates and metaphyses and 1 being confined in metaphysis, and 2 from the metaphyseal cortexes with 1 invading into epiphysis. Eccentric growth of CBT was noted in 8 of the 9 CBT in irregular bones. The detecting rates of intra-tumoral calcification, sclerotic rim and periosteal reaction were 54.1% (33/61), 73.8% (45/61), 32.8% (20/61) on DR; and 81.5% (44/54), 66.7% (36/54), 31.5% (17/54) on CT, respectively. The detecting rates of intra-tumoral fluid level and periosteal reaction on MRI were higher than those on CT (X² = 10.44, P < 0.01; X² = 12.19, P < 0.01, respectively). No significant differences in detecting rate were shown between CT and MRI in the respects of smooth contour, sclerotic rim, intra-tumoral calcification, osseous penetration, bone marrow reaction, soft-tissue mass and joint reaction. Nineteen CBT of type 1, 26 of type 2, 5 of type 3, 4 of type 4 and 7 of type 5 were found in the categorization. Conclusion: The calcified node of smooth contour and sclerotic rim comprises the characteristic imaging appearance of CBT. The 5-type categorization of CBT mass, and the peritumoral bone marrow reaction and joint reaction, enrich the imaging cognition to the tumor of CBT.