CAJ | 학술논문

目的：探讨肢体骨肉瘤新辅助化疗前后髓腔MRIT1像上信号的变化。方法回顾研究58例肢体骨肉瘤，将新辅助化疗前后髓腔的MRI T1像进行对比，记录化疗前患者的MRI T1像肿瘤与正常髓腔是否有清晰边界，化疗后分界是否仍清晰，不清晰出现的比例及信号变化。部分患者进行了双侧肢体 MRI检查，对比双侧MRI信号的异同。获得瘤段截除标本后，对化疗后出现信号改变的部位进行病理取材，研究这种信号改变的组织学构成。结果髓腔MRIT1信号形态可分为清晰、连续弥漫、间断岛状、间断弥漫4种，58例患者入院MRI上均为清晰的髓腔分界。化疗后MRI边界清晰22例，占37.9%，36例为化疗前MRI清晰而化疗后变为不清晰，占62.1%。其中连续弥漫20例，占34.5%；间断岛状4例，占6.9%；间断弥漫12例，占20.7%。9例化疗后 MRI 可显示双侧股骨，健侧股骨髓腔内也出现了与患侧股骨类似的斑片状弥漫信号。对33例MRIT1加权像上显示异常的区域进行取材，组织学显示为增生的骨髓造血细胞，无肿瘤细胞。结论新辅助化疗前后MRI T1像上显示的骨肉瘤髓内异常信号范围可发生变化，部分患者在新辅助化疗后出现瘤旁异常信号，对于这些肿瘤外的、形态上呈岛状及弥漫斑片状的异常信号，如在 MRI T1像上较脂肪信号低，较骨骼肌信号高，临床上要考虑到有可能发生了骨髓逆转换，是骨髓的正常变化，不能将这种增生骨髓误认为肿瘤的进展而造成截骨长度的增加。
목적：탐토지체골육류신보조화료전후수강MRIT1상상신호적변화。방법회고연구58례지체골육류，장신보조화료전후수강적MRI T1상진행대비，기록화료전환자적MRI T1상종류여정상수강시부유청석변계，화료후분계시부잉청석，불청석출현적비례급신호변화。부분환자진행료쌍측지체 MRI검사，대비쌍측MRI신호적이동。획득류단절제표본후，대화료후출현신호개변적부위진행병리취재，연구저충신호개변적조직학구성。결과수강MRIT1신호형태가분위청석、련속미만、간단도상、간단미만4충，58례환자입원MRI상균위청석적수강분계。화료후MRI변계청석22례，점37.9%，36례위화료전MRI청석이화료후변위불청석，점62.1%。기중련속미만20례，점34.5%；간단도상4례，점6.9%；간단미만12례，점20.7%。9례화료후 MRI 가현시쌍측고골，건측고골수강내야출현료여환측고골유사적반편상미만신호。대33례MRIT1가권상상현시이상적구역진행취재，조직학현시위증생적골수조혈세포，무종류세포。결론신보조화료전후MRI T1상상현시적골육류수내이상신호범위가발생변화，부분환자재신보조화료후출현류방이상신호，대우저사종류외적、형태상정도상급미만반편상적이상신호，여재 MRI T1상상교지방신호저，교골격기신호고，림상상요고필도유가능발생료골수역전환，시골수적정상변화，불능장저충증생골수오인위종류적진전이조성절골장도적증가。
Objective To investigate the signal changes of MRI T1-weighted images of the medullary cavity before and after the neoadjuvant chemotherapy for extremity osteosarcoma.Methods The clinical data of 58 cases of extremity osteosarcoma were retrospectively studied. The MRI T1-weighted images of the medullary cavity before and after the neoadjuvant chemotherapy were compared. It was recorded whether the margin between the tumor and the normal medullary cavity was clear before and after the chemotherapy, the occurrence of blurring and the signal changes. The MRI examination of bilateral limbs was performed on some patients. The signal differences between the 2 sides were compared. After the tumor-bearing segment was resected, the specimen of abnormal signals after the chemotherapy was analyzed pathologically. The histological structures of such signals were studied.Results The signal aspects of MRI T1-weighted images of the medullary cavity could be classiifed into 4 kinds, which were clear, continuous diffuse, discontinuous island-like and discontinuous diffuse respectively. Before the chemotherapy, the clear margin could be observed in all 58 patients. After the chemotherapy, the clear margin could be observed in 22 patients ( 37.9% ). It occurred to 36 patients ( 62.1% ) that signals changed from clear to unclear after the chemotherapy. There were 20 continuous diffuse cases ( 34.5% ), 4 discontinuous island-like cases ( 6.9% ) and 12 discontinuous diffuse cases ( 20.7% ). The MRI showed bilateral femurs in 9 cases after the chemotherapy. The patchy and diffuse signals in the medullary cavity of the normal femur were similar to those of the affected femur. The specimen was taken based on the MRI T1-weighted images of 33 cases which showed abnormal signals. The histological studies showed no tumor cells but the proliferation of hematopoietic cells.Conclusions The range of abnormal signals in the medullary cavity with osteosarcoma may change based on the MRI T1-weighted images before and after the neoadjuvant chemotherapy. The abnormal signals beyond the tumor are noticed in some patients after the neoadjuvant chemotherapy, which are island-like, diffuse and patchy. For those signals that are lower than subcutaneous fat signals and higher than skeletal muscle signals, the marrow reconversion should be considered clinically, which is not the tumor progress but the normal marrow change. If misdiagnosed, the osteotomy length will be increased.