摘要
目的探讨不同影像方法在瘤源性骨质软化病变的影像学表现。方法8例瘤源性骨质软化患者年龄28～69岁,平均44.1岁,其中男5例,女3例。所有患者的骨质软化诊断依据临床检查和X线表现。主要实验室检查包括血清钙、磷、碱性磷酸酶活性、甲状旁腺激素、尿磷和肝肾功能。根据临床寻找瘤源性骨质软化病变的需求,所有患者均先行99mTC生长抑素核素扫描检查。MR检查8例,螺旋CT检查4例,对MR、CT发现的4例骨内病变又进一步行常规X线检查4例。所有局部病变均行手术切除并得取病理诊断。结果所有患者实验室检查均示血磷降低(0.29～0.65mmol·L-1),碱性磷酸酶(36.6～310.6μmol·s-1·L-1)和尿磷增高(11.5～40.9mmol·L-1),但甲状旁腺水平和肝、肾功能均正常。术后病理结果为:软组织肿瘤4例(血管瘤、腱鞘巨细胞瘤、血管外皮细胞瘤和间叶细胞瘤各1例);骨肿瘤4例(恶性神经纤维瘤1例,间叶细胞瘤2例和纤维母细胞瘤1例)。所有病变区的奥曲肽显像均示异常浓聚,但不足以区分病变是源于骨还是软组织,而MR影像可进行这种区分。所有病变的T1WI示低或等强度信号,T2WI示高强度信号;病变的边界均清晰;信号强度不均匀者6例,均匀者2例;4例病理证实的骨肿瘤中有2例CT和X线显示恶性的骨质破坏征象,如边界不清等。结论对年长、血钙和甲旁状腺激素正常且低血磷的骨质软化,应首选奥曲肽显像检查用以寻找瘤源性骨质软化病变,进一步结合MR、CT或X线所见有助于病变性质的分析。
Objective To compare images from different medality for detecting lesions in patients with oncagenic osteomalacia. Methods Eight patients with oncogenic osteomalacia were recruited in this study. The age ranged from 28 to 69 years （mean age 44. 1, 5 men and 3 women）. All patients were diagnosed as osteomalacia according to their clinical and radiographic manifestations. Main laboratory tests included serum calcium, phosphorus, alkaline phosphatase activity, parathyroid hormone, urinary phosphorus as well as liver and renal functions. Octreotide scans were performed for all patients according to clinical request for confirming the oncogenic osteomalacia. Further examinations of MR imaging in 8 patients, spiral CT in four patients and conventional radiography in four patients were obtained after the octreotide scans respectively. All patients had operation for their tumor resections and for the pathologic diagnostic findings. Results Abnormal laboratory findings in all patients included low serum phosphorus level （ ranged from 0. 29 to 0. 65 mmol · L ^-1 ）, elevated alkaline pbosphatase activity （ ranged from 36. 6 to 310. 6 μmol · s^-1 · L^-1） as well as urinary phosphorus level （ranged fjrom 11.5 to 40. 9 mmol · L^-1 ）. Normal results included parathyroid hormone level, liver and renal functions. Pathology confirmed the diagnosis of 4 soft tissue tumors including 1 hemangiomas, 1 giant-cell tumor of tendon sheath, 1 hemangiopericytoma and 1 mensenchymal tumor, as well as 4 bone tumors including 1 malignant neurofibroma, 2 mensenchymal tumors and 1 fibroblastoma. All lesions were shown abnormal region of increasing uptake tracer on octreotide scans. However, the octreotide scans could not determine where （ bone or soft tissues） the lesions located. MR imaging could differentiate the lesions within the bone or within the soft tissues in all patients. All lesions had hypo- or iso- signal intensity on T1 WI and high signal intensity on T2 WI with heterogeneous in 6 tumors and homogeneous in 2 tumors. In 2 cases of the four pathologic confirmed bone tumors, radiography or CT could show malignant imaging findings including bone destruction, ill-defined margin, etc. Conclusion For adult osteomalacia patients with normal serum calcium and parathyroid hormone and low serum phosphorus, octreotide should be primary chosen for confirming oncogenic osteomalacia. Octreotide combined with MR imaging, CT or radiography would be useful for further analyzing imaging features of the tumors.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2006年第6期616-620,共5页
Chinese Journal of Radiology
关键词
骨质软化症
软组织肿瘤
骨肿瘤
诊断显像
Osteomalacia
Soft tissue neoplasms
Bone neoplasms
Diagnostic imaging
