CAJ | 학술논문

目的：探讨去分化软骨肉瘤的影像学表现及诊断价值。方法收集2006年9月～2013年9月间经病理证实的26例去分化软骨肉瘤患者，髂骨11例，股骨6例，肱骨3例，胫骨2例，肋骨2例，脊柱2例。结果软骨肉瘤合并纤维肉瘤1例，恶性纤维组织细胞瘤4例，骨肉瘤4例，骨膜骨肉瘤1例，以及梭形细胞肉瘤16例。影像学特征性表现为“双相征”，即呈现两种不同肿瘤的影像学特征，X线显示比例为55．6％，C T为66．7％，除髓腔内具有环形、点状钙化的软骨类肿瘤病灶外，相邻局部骨质溶解破坏区伴骨旁无钙化的软组织肿块；MRI为57．1％，T2 WI表现为分界较清楚的分叶状高信号与不规则低信号软组织肿块，高信号区在增强后呈周围及间隔强化，相对低信号区呈明显均匀强化。结论在软骨类肿瘤表现的基础上，X线及CT上病灶内局部骨溶解区及无钙化软组织肿块，或MR T2序列上不规则低信号区及均匀强化特征，高度提示病灶内两种病理成分并存即去分化软骨肉瘤的可能。
목적：탐토거분화연골육류적영상학표현급진단개치。방법수집2006년9월～2013년9월간경병리증실적26례거분화연골육류환자，가골11례，고골6례，굉골3례，경골2례，륵골2례，척주2례。결과연골육류합병섬유육류1례，악성섬유조직세포류4례，골육류4례，골막골육류1례，이급사형세포육류16례。영상학특정성표현위“쌍상정”，즉정현량충불동종류적영상학특정，X선현시비례위55．6％，C T위66．7％，제수강내구유배형、점상개화적연골류종류병조외，상린국부골질용해파배구반골방무개화적연조직종괴；MRI위57．1％，T2 WI표현위분계교청초적분협상고신호여불규칙저신호연조직종괴，고신호구재증강후정주위급간격강화，상대저신호구정명현균균강화。결론재연골류종류표현적기출상，X선급CT상병조내국부골용해구급무개화연조직종괴，혹MR T2서렬상불규칙저신호구급균균강화특정，고도제시병조내량충병리성분병존즉거분화연골육류적가능。
Objective To analyze the imaging features and their diagnostic value for dedifferentiated chondrosarcoma (DDCS) .Methods 26 cases of DDCS (15 males ,11 females) ,with an average age of 52 .4 years old ,were confirmed by pathology results .In these cases ,the lesions involved the pelvis in 11 ,the femur in 6 ,the humerus in 3 ,the tibia in 2 , the rib in 2 ,the vertebra in 2 cases .9 patients underwent plain radiography ,12 patients underwent computed tomography (CT) ,and 14 underwent magnetic resonance imaging (MRI) .Results DDCS consisted of chondrosarcoma and dedifferen‐tiated components ,which were classified as fibrosarcomas in 1 ,malignant fibrous‐histiocytomas in 4 ,osteosarcomas in 4 , periosteal osteosarcomas in 1 and undifferentiated sarcomas in 16 .Part of lesions were shown “bimorphic features” with different tumor features juxtaposed within the lesion ,55 .6% of the radiographs ,66 .7% of the CT scans displayed a dom‐inant lytic area and a large ,unmineralized soft‐tissue mass adjacent to an intraosseous chondroid‐containing tumor .57 .1%of the MRI T2WI showed a lobulate hyperintense mass in combination with a region of atypical reduced signal intensity , with contrast medium .Hyperintense lesions were demonstrated septal and peripheral enhancement ,however ,the reduced signal lesions were shown homogeneous enhancing characteristic .Conclusion Based on cartilaginous tumors lesions ,a dominant lytic area and a large unmineralized soft‐tissue mass at radiograph and CT ,or a region of atypical reduced signal intensity with homogeneous enhancement at T2 WI imaging can help predict dedifferentiation .