骨肉瘤之病例分析及放射線學徵象

Osteosarcoma-Roentgenographic Findings and Cases Analysis

周宜宏(Yi-Hong Chou) ； 潘慧本(Huay-Ben Pan) ； 刁翠美(Chui-Mei Tiu) ； 張遵(Tsuen Chang)

《中華放射線醫學雜誌》 7卷2期 (1982/06) Pp. 108-118

摘要

榮民總醫院自1975年至1979年五年內，共有四十二例經開刀證實為骨肉瘤之住院病患，其中有23例有完整之放射線資料。其年齡自12歲至54歲，除54歲一人外其餘22例均小於30歲。男女比為三比一。20例(87%)發生於膝關節附近之長骨上。病人多以患部痛性腫脹為主訴。實驗室數據除約半數病患有血清鹼性磷酸酶及乳酸去氫酶上升外並無特殊變化；其中鹼性磷酸酶於開刀後多下降，而乳酸去氫酶上升可能與肺部轉移有關。放射線檢查呈現軟組織腫塊者有23人(100%)；骨皮質之變化者20人(87%)，主要為侵蝕性(Permeative，35%)，蛾咬狀(22%)或地圖狀(22%)骨破壞。骨膜反應18人(78%)，主要為層狀(35%)，垂直紋(39%)或Codman氏三角(43%)。14人可見腫瘤骨(61%)。所有23例在第一次所作之放射線圖像中即可作出正確之骨肉瘤之診斷，僅一例生長於骨幹者為高度懷疑為骨肉瘤而仍須與Ewing氏肉瘤作鑑別診斷。23例中有二例施行血管造影，對骨肉瘤之軟組織侵犯及其真正蔓延範圍之確定甚有助益。傳統放射線檢查在骨肉瘤之診斷仍為最具價值之工具。

並列摘要

Forty-two cases of osteosarcoma were found in the admitted patients in Veterans General Hospital from 1975 to 1979. Twenty-three cases got enough X-ray pictures for analysis. Ages ranged from 12 to 54 yr. old. Twenty-two cases were below thirty years old. The male to female ratio was 3:1. Twenty cases (87%) occurred in the long bones adjacent to the knee joint. The chief complaint among most patients was painful swelling at the lesion site. Laboratory findings showed elevation of the alkaline phosphatase and lactic dehydrogenase in half of the patients, otherwise the other findings were within normal limit. After surgical intervention, the alkaline phosphatase decreased in most of the cases while the elevation of the lactic dehydrogenase might be related to lung metastases. Roentgenographic findings included soft tissue swelling in all 23 cases (100%), cortical changes in 20 cases (87%). The cortical changes were divided into three main types: permeative 35%, moth-eaten 22% and geographic bony destruction 22%. Presence of periosteal reaction in 18 cases (78%), these included lamellated 35%, perpendicular striae 39% and Codman's triangle 43%. 14 cases (61%) got tumor bone. The diagnosis of osteosarcoma was made in all 23 cases from the first X-ray picture. Only one case which occurred in the diaphysis of the long bone needed to be differentiated from Ewing sarcoma. Only two cases out of the 23 had performed angiographic examination which was helpful for the determination of soft tissue involvement and extension of the tumor. Conventional X-ray examination is still the most useful and valuable tool in the diagnosis of osteosarcoma.