如何簡(jiǎn)單有效的鑒別骨腫瘤良惡性

骨腫瘤種類繁多，良惡性各異，如何有效鑒別其良惡性對(duì)臨床治療方案的選擇至關(guān)重要。一、良性骨腫瘤單純骨囊腫(SimplebonecystSBC)成軟骨細(xì)胞瘤(Chondroblastoma)非骨化性纖維瘤(NonOssifyingFibromaNOF)骨軟骨瘤(Osteochondroma)纖維性結(jié)構(gòu)不良午讓知垃dysplasiaFD)骨樣骨瘤(Osteoidosteoma)動(dòng)脈瘤樣骨囊腫(Aneurysmalbonecyst，ABC)嗜酸性肉芽腫(EosinophilicgranulomaEG)骨巨細(xì)胞瘤(GiantcelltumorGCT)內(nèi)生軟骨瘤(Enchondroma)骨瘤(Osteoma)二、惡性骨腫瘤尤文肉瘤(Ewingsarcoma)骨肉瘤(Osteosarcoma)纖維肉瘤(Fibrosarcoma)骨膜外肉瘤(Parostealsarcoma)軟骨肉瘤(Chondrosarcoma)骨髓瘤(Myeloma)轉(zhuǎn)移瘤(Metastases)10 203040506010 2030405060脊髓瘤（Chordoma）對(duì)于腫瘤良惡性鑒別的指標(biāo)較為復(fù)雜，對(duì)于初學(xué)者，如何簡(jiǎn)單、快速、有效的進(jìn)行鑒別?結(jié)合TheRadiologyAssistants站的資料，我們主要通過(guò)年齡、病變位置和影像征象三個(gè)方面對(duì)骨腫瘤的良惡性進(jìn)行鑒別。1.年齡SimpleBoneCystEwingsarcorriaCbondrobfastomaNOFOateochondromaFibrousdysplasiaOstecsarcamaOsteoidosteomaAneurysmalbonecystEosinopliiJicgranulomaGiantcellltumourEnchondromaFibrosarcomaOsteomaPanosteaisarcoma

ChondrosarcomaMyelomaMetaslaseeChordomaIO20 30405060圖1常見(jiàn)骨腫瘤發(fā)病年齡分布圖，其中紅色為惡性，藍(lán)色為良性發(fā)病年齡是鑒別骨腫瘤重要的參考指標(biāo)，從上述圖中可以看出，30歲為鑒別良惡性骨腫瘤的最佳臨界點(diǎn)（cutoff。30歲以下，骨腫瘤多為良性（藍(lán)色），僅有Ewing肉瘤和骨肉瘤（Osteosarcoma）為惡性（紅色）

30歲以上，骨腫瘤多為惡性，僅有骨巨細(xì)胞瘤(GiantcelltumOr和內(nèi)生軟骨肉瘤(Enchondroma)良性。.病變位置SKull:EG,mels,myeJomalUlFindible:Adamantinoma,dentageniccystHumenis：All,SBCAroundtheKnee：:AN,Osteosarc,Ewing,SKull:EG,mels,myeJomalUlFindible:Adamantinoma,dentageniccystHumenis：All,SBCAroundtheKnee：:AN,Osteosarc,Ewing,PeMs:Osteosarcoma,Ctiondrasarc,S8CLymphoma,EwinghEG,ChordomaDistalradius：GCXEGHands:Enchondroma,ProKFemujf：SBC,FO,EnchondromaEwing,EGTibiashaft:NOFdFD,AdamantincimaOsteoidosieamaCalcaneus:SBCrEming.OsteoblastomaChondroblasloina '二--1一Ribs:Mets,EnchondrfCtiondrosarc4EwingSpin審Me限M評(píng)iom電Osteoblastoma,ChordomaHermangiomahABChOsteoidofitema,圖2不同骨腫瘤常見(jiàn)發(fā)病位置示意圖

結(jié)合年齡+病變位置，可以更好的對(duì)腫瘤類型進(jìn)行鑒別NQFEnchondOst&oGiantCTinfcctiiintectian-ChonKfroblaslomsOsteoid^sleoinia\Ostco匕NQFEnchondOst&oGiantCTinfcctiiintectian-ChonKfroblaslomsOsteoid^sleoinia\Ostco匕h0ndimmaWiplwmaMyeloma圖3不同年齡階段股骨常見(jiàn)骨腫瘤及發(fā)病位置.影像學(xué)征象骨膜反應(yīng)當(dāng)腫瘤、感染、創(chuàng)傷等引起骨膜刺激時(shí)即可發(fā)生。輕微骨膜反應(yīng)：良性骨腫瘤和創(chuàng)傷后。明顯骨膜反應(yīng)：惡性腫瘤，也見(jiàn)于有侵襲性的良性病變，如感染和嗜酸性肉芽腫。Periostealr5actTonSpiculatedSolidLamellatedCodmanJsBenignPeriostealr5actTonSpiculatedSolidLamellatedCodmanJsBenignAggressiveVeryAggressive圖4骨膜反應(yīng)示意圖，實(shí)性(Solid)多為良性；板層狀(Lamellated)和毛刺放射狀(Spiculated)提示病變多有侵襲性，當(dāng)骨膜反應(yīng)呈Codman三角提示腫瘤惡性程度較高腫瘤邊界骨腫瘤的邊界多可分為邊界清楚(Well-defined、邊界模糊(ill-definhc和骨化(SclerotiC。

EwingFibrdysplasiaABCChondroblastCMFOstecsarcomaInfectionInfectionEGSBCEG-EwingOsteosarcomaLeukemiaAgej'WeiJ-definedr -、EnchondromaEwingFibrdysplasiaABCChondroblastCMFOstecsarcomaInfectionInfectionEGSBCEG-EwingOsteosarcomaLeukemiaAgej'WeiJ-definedr -、EnchondromaOsteomaBoneislandParOStealOsteosarHealedlesions;?NOF,EG-SBC,ABC-Chendroblastill-defined圖5常見(jiàn)骨腫瘤根據(jù)邊界及年齡進(jìn)行分類圖；GiantCTEnchondromaChondrosarcoma(lowgrade)HPT-BrowntumorOst€b2stoma1jGiantCT< J20-4040+L J? jMetastasesMyelomaGeodeJ A， TlAllagesInfectionL _1MetastasesMyelomaChondrosarcoma(highgrade)1）邊界清楚邊界清楚常是病變緩慢生長(zhǎng)的標(biāo)志，硬化邊更是表明病變低生物活性。30歲以下患者邊界清楚的病變意味著我們可將其當(dāng)良性病變處理。30歲以上，特別是超過(guò)40歲的患者，即使影像上表現(xiàn)為良性的病變，也需要考慮轉(zhuǎn)移瘤和漿細(xì)胞瘤的可能。40歲以上患者，轉(zhuǎn)移瘤和多發(fā)性骨髓瘤是最常見(jiàn)的骨腫瘤?；加猩窠?jīng)母細(xì)胞瘤、橫紋肌肉瘤或視網(wǎng)膜母細(xì)胞瘤等原發(fā)腫瘤的年輕患者，鑒別診斷里需包括轉(zhuǎn)移瘤。2）邊界模糊邊界不清常是浸