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目的：提高对肝癌以骨转移为首发症状的认识。方法：复习３例经手术和／或病理证实的骨转移为首发症状的肝癌影像学表现。结果：额顶及骶骨各１例，均表现为溶骨性骨破坏及局部出现软组织肿块。血管造影显示病变区有丰富的血供。腰椎１例，为腰１～２椎体溶骨破坏。结论：我国为肝癌高发区，肝癌的血行转移是最常见的，但骨转移为首发症状者比较少见，尤其发生于颅骨，往往因病史及肝区症状不明显而误诊。我们认为对任何溶骨性骨破坏病例，应经常要考虑肝癌骨转移的可能，建议常规作肝脏的Ｂ超、ＣＴ或ＡＦＰ检测。
Objective: To improve the understanding of liver cancer with bone metastases as the first symptom. METHODS: We reviewed the imaging findings of 3 cases of primary liver cancer with surgically and/or pathologically confirmed bone metastases. RESULTS: One case of the frontal tarsal bone and tibia was shown to be osteolytic bone destruction and localized soft tissue mass. Angiography showed a rich blood supply in the lesion area. One case of lumbar spine was broken by 1 to 2 vertebrae. Conclusion: In our country, the hematopoietic metastasis of hepatocellular carcinoma is the most common in high-risk areas of hepatocellular carcinoma. However, bone metastasis is the first symptom, and it is rare in the skull. It is often misdiagnosed because of history and indistinct symptoms in the liver. We believe that for any osteolytic bone destruction cases, we should always consider the possibility of bone metastasis from liver cancer. It is recommended to routinely perform liver ultrasonography, CT or AFP testing.