PDF(Pubmed)
Abstract：
The differentiation between the atypical cartilaginous tumor (ACT) and the enchondromas is crucial as ACTs require a curettage and clinical as well as imaging follow-ups, whereas in the majority of cases enchondromas require neither a treatment nor follow-ups. Differentiating enchondromas from ACTs radiologically remains challenging. Therefore, this study evaluated imaging criteria in a combination of computed tomography (CT) and magnetic resonance (MR) imaging for the differentiation between enchondromas and ACTs in long bones. A total of 82 patients who presented consecutively at our institution with either an ACT (23, age 52.7 ±18.8 years; 14 women) or an enchondroma (59, age 46.0 ± 11.1 years; 37 women) over a period of 10 years, who had undergone preoperative MR and CT imaging and subsequent biopsy or/and surgical removal, were included in this study. A histopathological diagnosis was available in all cases. Two experienced radiologists evaluated several imaging criteria on CT and MR images. Likelihood of an ACT was significantly increased if either edema within the bone (p = 0.049), within the adjacent soft tissue (p = 0.006) or continuous growth pattern (p = 0.077) were present or if the fat entrapment (p = 0.027) was absent on MR images. Analyzing imaging features on CT, the likelihood of the diagnosis of an ACT was significantly increased if endosteal scalloping >2/3 (p < 0.001), cortical penetration (p < 0.001) and expansion of bone (p = 0.002) were present and if matrix calcifications were observed in less than 1/3 of the tumor (p = 0.013). All other imaging criteria evaluated showed no significant influence on likelihood of ACT or enchondroma (p > 0.05). In conclusion, both CT and MR imaging show suggestive signs which can help to adequately differentiate enchondromas from ACTs in long bones and therefore can improve diagnostics and consequently patient management. Nevertheless, these features are rare and a combination of CT and MR imaging features did not improve the diagnostic performance substantially.
摘要：
非典型软骨肿瘤（ACT）和内生软骨瘤之间的区别至关重要，因为ACT需要刮治和临床以及影像学随访，而在大多数情况下，内生瘤既不需要治疗也不需要随访。在放射学上区分内生软骨瘤与ACTs仍然具有挑战性。因此,这项研究评估了计算机断层扫描（CT）和磁共振（MR）成像相结合的成像标准，以区分长骨中的内生软骨瘤和ACT。共有82名患者在我们的机构中连续出现ACT（23名，年龄52.7±18.8岁；14名女性）或内生软骨瘤（59名，年龄46.0±11.1岁；37名女性），进行了术前MR和CT成像以及随后的活检或/和手术切除，包括在这项研究中。所有病例均可进行组织病理学诊断。两位经验丰富的放射科医生评估了CT和MR图像的几种成像标准。如果骨内水肿（p=0.049），则ACT的可能性显着增加。在邻近的软组织内（p=0.006）或连续生长模式（p=0.077）存在，或者如果MR图像上没有脂肪截留（p=0.027）。分析CT影像特征,如果骨内扇贝形成2/3（p<0.001），则诊断为ACT的可能性显着增加。存在皮质渗透（p＆lt;0.001）和骨扩张（p=0.002），如果在不到1/3的肿瘤中观察到基质钙化（p=0.013）。评估的所有其他成像标准对ACT或内生软骨瘤的可能性没有显着影响（p＆gt;0.05）。总之,CT和MR成像都显示了暗示性体征，这些体征可以帮助充分区分长骨中的内生软骨瘤和ACTs，因此可以改善诊断，从而改善患者管理。然而，这些特征很少见,CT和MR成像特征的结合并没有显著提高诊断效能.
