Abstract：
OBJECTIVE: To evaluate the results of total-body (TB) MRI used as a screening tool for assessment or exclusion of malignant transformation in patients with hereditary multiple osteochondromas (HMO).
METHODS: In a single-institute cohort of MO patients, 366 TB-MRI examinations, including T1-weighted and STIR images, were performed for screening and follow-up purposes to rule out the malignant transformation, and retrospectively analyzed. In each patient, the presence and location of osteochondromas in the axial and appendicular bones were recorded. Forty-seven patients underwent a second TB surveillance in this period. STIR sequences were used to identify sites of increased signal intensity that could represent suspicious thickened cartilage caps or indeterminate reactive changes related to osteochondromas.
RESULTS: In 82% of patients, one or more OC locations were determined in one or more flat bones. In 366 exams, nine OC (2,5 %) with suspicious imaging features were identified. These proved to be peripheral chondrosarcomas after targeted MRI and resection were performed. All nine malignant lesions were in flat bones (pelvis 5, ribs 3, scapula 1). Three of these patients were 19 years of age. In 12 patients who had peripheral or intraosseous low-grade chondrosarcoma in their history, before their first TB-MRI, no new lesions were identified. Twenty-three additional TB-MRI exams, demonstrating focal high T2 signal intensity, also gave rise to performing additional targeted MRI. One OC of the distal femur was excised and appeared benign. No suspicious cartilage caps were depicted on the remaining 22 targeted MRI exams but instead increased T2 signal was clarified by reactive changes (frictional bursitis, soft tissue edema) in close relation with benign osteochondromas. No malignant lesions were found in 47 patients who had a second TB surveillance (mean interval between exams 3.2 years, range 2-5 years).
CONCLUSIONS: TB-MRI can identify malignant transformation of osteochondromas in HMO patients. All peripheral chondrosarcomas occurred in flat bones (ribs, scapula, pelvis) in our study. TB-MRI might assist in triage between higher risk patients with a high burden of OC, including the location of OC in main flat bones vs lower risk patients without OC of the flat bones.
METHODS: In a single-institute cohort of MO patients, 366 TB-MRI examinations, including T1-weighted and STIR images, were performed for screening and follow-up purposes to rule out the malignant transformation, and retrospectively analyzed. In each patient, the presence and location of osteochondromas in the axial and appendicular bones were recorded. Forty-seven patients underwent a second TB surveillance in this period. STIR sequences were used to identify sites of increased signal intensity that could represent suspicious thickened cartilage caps or indeterminate reactive changes related to osteochondromas.
RESULTS: In 82% of patients, one or more OC locations were determined in one or more flat bones. In 366 exams, nine OC (2,5 %) with suspicious imaging features were identified. These proved to be peripheral chondrosarcomas after targeted MRI and resection were performed. All nine malignant lesions were in flat bones (pelvis 5, ribs 3, scapula 1). Three of these patients were 19 years of age. In 12 patients who had peripheral or intraosseous low-grade chondrosarcoma in their history, before their first TB-MRI, no new lesions were identified. Twenty-three additional TB-MRI exams, demonstrating focal high T2 signal intensity, also gave rise to performing additional targeted MRI. One OC of the distal femur was excised and appeared benign. No suspicious cartilage caps were depicted on the remaining 22 targeted MRI exams but instead increased T2 signal was clarified by reactive changes (frictional bursitis, soft tissue edema) in close relation with benign osteochondromas. No malignant lesions were found in 47 patients who had a second TB surveillance (mean interval between exams 3.2 years, range 2-5 years).
CONCLUSIONS: TB-MRI can identify malignant transformation of osteochondromas in HMO patients. All peripheral chondrosarcomas occurred in flat bones (ribs, scapula, pelvis) in our study. TB-MRI might assist in triage between higher risk patients with a high burden of OC, including the location of OC in main flat bones vs lower risk patients without OC of the flat bones.
摘要：
目的：评估全身（TB）MRI作为评估或排除遗传性多发性骨软骨瘤（HMO）患者恶性转化的筛查工具的结果。
方法：在单研究所的MO患者队列中，366TB-MRI检查，包括T1加权和STIR图像，进行筛查和随访以排除恶性转化，并进行回顾性分析。在每个病人中,记录中轴骨和阑尾骨中骨软骨瘤的存在和位置.在此期间，47名患者接受了第二次结核病监测。STIR序列用于识别信号强度增加的部位，这些部位可能代表可疑的软骨帽增厚或与骨软骨瘤有关的不确定的反应性变化。
结果：在82%的患者中，在一个或多个平坦骨骼中确定一个或多个OC位置。在366次考试中，确定了9个具有可疑影像学特征的OC（2,5％）。在进行靶向MRI和切除后，这些被证明是周围软骨肉瘤。所有9个恶性病变均位于扁平骨（骨盆5，肋骨3，肩胛骨1）。这些患者中有3名年龄为19岁。在12例有外周或骨内低级别软骨肉瘤的患者中，在他们的第一次结核病核磁共振成像之前，没有发现新的病变.23个额外的TB-MRI检查,显示局灶性高T2信号强度，还导致进行额外的靶向MRI.切除了股骨远端的一个OC，呈良性。在其余22次靶向MRI检查中没有描绘可疑的软骨帽，而是通过反应性变化（摩擦性滑囊炎，软组织水肿）与良性骨软骨瘤密切相关。在进行第二次结核病监测的47例患者中未发现恶性病变（检查之间的平均间隔为3.2年，范围2-5年)。
结论：TB-MRI可以发现HMO患者骨软骨瘤的恶性转化。所有周围软骨肉瘤均发生在扁平骨（肋骨，肩胛骨,骨盆）在我们的研究中。TB-MRI可能有助于在OC负担较高的高风险患者之间进行分诊，包括OC在主要平坦骨骼中的位置与无OC的较低风险患者的位置。
方法：在单研究所的MO患者队列中，366TB-MRI检查，包括T1加权和STIR图像，进行筛查和随访以排除恶性转化，并进行回顾性分析。在每个病人中,记录中轴骨和阑尾骨中骨软骨瘤的存在和位置.在此期间，47名患者接受了第二次结核病监测。STIR序列用于识别信号强度增加的部位，这些部位可能代表可疑的软骨帽增厚或与骨软骨瘤有关的不确定的反应性变化。
结果：在82%的患者中，在一个或多个平坦骨骼中确定一个或多个OC位置。在366次考试中，确定了9个具有可疑影像学特征的OC（2,5％）。在进行靶向MRI和切除后，这些被证明是周围软骨肉瘤。所有9个恶性病变均位于扁平骨（骨盆5，肋骨3，肩胛骨1）。这些患者中有3名年龄为19岁。在12例有外周或骨内低级别软骨肉瘤的患者中，在他们的第一次结核病核磁共振成像之前，没有发现新的病变.23个额外的TB-MRI检查,显示局灶性高T2信号强度，还导致进行额外的靶向MRI.切除了股骨远端的一个OC，呈良性。在其余22次靶向MRI检查中没有描绘可疑的软骨帽，而是通过反应性变化（摩擦性滑囊炎，软组织水肿）与良性骨软骨瘤密切相关。在进行第二次结核病监测的47例患者中未发现恶性病变（检查之间的平均间隔为3.2年，范围2-5年)。
结论：TB-MRI可以发现HMO患者骨软骨瘤的恶性转化。所有周围软骨肉瘤均发生在扁平骨（肋骨，肩胛骨,骨盆）在我们的研究中。TB-MRI可能有助于在OC负担较高的高风险患者之间进行分诊，包括OC在主要平坦骨骼中的位置与无OC的较低风险患者的位置。
