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目的探讨软组织影像改变对骨髓炎和恶性骨肿瘤的鉴别诊断价值。方法通过回顾性分析,对57例骨髓炎和70例恶性骨肿瘤患者软组织异常 CT 和 MRI 征象进行界定、观察、记录和统计学比较。结果 57例骨髓炎患者中,CT 检查54例,MR 检查14例。CT 检查的54例中,软组织肿胀52例(Ⅰ度19例、Ⅱ度16例、Ⅲ度17例),脓肿样囊腔6例,软组织肿块5例,软组织内气体、脂液平面和窦道各1例。MR 检查的14例骨髓炎中,软组织肿胀14例(Ⅰ度2例、Ⅱ度6例、Ⅲ度6例),脓肿样囊腔(扩散加权成像均呈明显高信号)3例,软组织肿块和脂液平面各1例。70例恶性骨肿瘤患者中,CT 检查54例,MR 检查49例。CT 检查的54例中,软组织肿胀44例(Ⅰ度29例、Ⅱ度12例、Ⅲ度3例),软组织肿块49例,软组织肿块边缘残留骨壳或壳样钙化16例,软组织肿块内肿瘤骨或瘤软骨钙化25例。MR 检查的49例恶性骨肿瘤中,软组织肿胀46例(Ⅰ度21例、Ⅱ度17例、Ⅲ度8例),软组织肿块43例。骨髓炎组和恶性骨肿瘤组 CT 图像显示的软组织肿胀程度(Uc=4.1066,P<0.01)以及脓肿样囊腔(χ~2=4.4118,P<0.05)、肿块(χ~2=71.7037,P<0.01)、肿块边缘残留骨壳或壳样钙化(χ~2=18.7826,P<0.01)和肿块内肿瘤骨或瘤软骨钙化(χ~2=32.5301,P<0.01)出现比例差异具有统计学意义。MR 图像所示的软组织肿胀程度(Uc=2.5997,P<0.01)以及脓肿样囊腔(四格表确切概率 P=0.0092)和肿块(χ~2=29.8757,P<0.01)出现比例差异亦有统计学意义。结论软组织肿胀程度和软组织肿块对骨髓炎和恶性骨肿瘤鉴别具有一定价值。软组织肿块边缘残留骨壳或壳样钙化以及软组织肿块内肿瘤骨或瘤软骨钙化是恶性骨肿瘤的特异性征象。脓肿样囊腔、软组织内气体、脂液征和窦道是骨髓炎的可靠征象。
Objective To investigate the differential diagnosis of osteomyelitis and malignant bone tumor with soft tissue imaging. Methods A retrospective analysis of 57 cases of osteomyelitis and 70 cases of malignant bone tumors of soft tissue abnormal CT and MRI signs were defined, observed, recorded and statistical comparison. Results 57 cases of osteomyelitis patients, CT examination in 54 cases, MR examination in 14 cases. Of the 54 cases examined by CT, 52 cases had soft tissue swelling (19 cases of grade Ⅰ, 16 cases of grade Ⅱ and 17 cases of degree Ⅲ), 6 cases of abscess-like cyst, 5 cases of soft tissue mass, gas, lipid plane and sinus One case each. Among the 14 osteomyelitis patients examined by MR, there were 3 cases of soft tissue swelling (2 in grade Ⅰ, 6 in grade Ⅱ, 6 in grade Ⅲ), 3 in abscess-like cysts (all were significantly high in diffusion weighted imaging), 3 in soft tissue mass and Lipid plane in 1 case. Among 70 patients with malignant bone tumors, CT was performed in 54 cases and MR was performed in 49 cases. Of the 54 cases examined by CT, 44 cases had soft tissue swelling (29 in grade Ⅰ, 12 in grade Ⅱ and 3 in grade Ⅲ), 49 in soft tissue mass, 16 in remnant bone shell or shell-like calcification on the edge of soft tissue mass, 25 cases of bone or tumor cartilage calcification. Of the 49 malignant bone tumors examined by MR, 46 had soft tissue swelling (21 cases of grade I, 17 cases of grade II and 8 cases of grade III) and 43 cases of soft tissue mass. The CT images of osteomyelitis group and malignant bone tumor group showed the degree of soft tissue swelling (Uc = 4.1066, P <0.01) and the abscess-like cyst cavity (χ ~ 2 = 4.4118, (P <0.01). There was a statistically significant difference in the percentage of residual bone shell or shell-like calcification at the edge of the tumor (χ ~ 2 = 18.7826, P <0.01) and tumor cartilage calcification (χ ~ 2 = 32.5301, significance. The difference in the extent of soft tissue swelling (Uc = 2.5997, P <0.01) as well as abscess-like cysts (exactness of the four-table scale, P = 0.0092) and the mass (χ ~ 2 = 29.8757, P <0.01) Statistical significance. Conclusion The degree of soft tissue swelling and soft tissue mass has certain value in differentiating osteomyelitis and malignant bone tumor. Residual bone crust or shell-like calcification at the margin of soft tissue mass, as well as tumor bone or tumor cartilage calcification within soft tissue mass, are specific signs of malignant bone tumors. Abscess-like cysts, gas within the soft tissue, fat fluid sign, and sinus are reliable signs of osteomyelitis.