目的 探讨在CT基础上骨与软组织肿瘤术后复发与瘢痕在超声和MRI的不同表现，评价超声对鉴别术后肿瘤复发与瘢痕形成的临床诊断价值。 方法 回顾性分析2016年01月至2021年07月南方医科大学第三附属医院骨肿瘤科收治的50例骨与软组织肿瘤术后疑似复发患者，年龄8~84岁，平均年龄（36.2±19.5）岁，男性21例，女性29例。发生部位于四肢42例，骨盆环6例，脊柱2例。所有病例均行超声、CT及MRI检查，由主要从事肌骨系统的超声科、放射科副主任或主任医师各1名，在CT基础上，超声和MRI分别进行诊断。所有病例均有手术切除或穿刺活检的病理结果。 结果 50例中病理确诊复发40例，瘢痕10例。超声诊断的灵敏度、特异度、准确率分别是97.50%、90.00%、96.00%；MRI的灵敏度、特异度、准确率分别是92.50%、40.00%、82.00%。超声的特异度和准确率高于MRI，两者差异具有统计学意义（P<0.05），两者敏感度相当，差异无统计学意义（P>0.05）。在有内固定物存留患者中超声的特异度（85.71%）高于MRI（42.86%），两者差异有统计学意义（P<0.05）。 结论 超声在鉴别诊断骨与软组织肿瘤术后复发及瘢痕形成中，特别是在行内固定术后体内固定物对CT或磁共振的显像产生影响的情况下，可提高骨肿瘤复发的诊断效率，值得临床推广。
Abstract
Objective To investigate the different manifestations of postoperative recurrence and scar of bone and soft tissue tumors on CT and MRI, and to evaluate the clinical diagnostic value of ultrasound in differentiating postoperative tumor recurrence and scar formation. Methods Fifty patients with suspected recurrence of bone and soft tissue tumors treated in the Department of Bone Oncology of the Third Affiliated Hospital of Southern Medical University from January 2016 to July 2021 were retrospectively analyzed, aged 8-84 years, with an average age of (36.2±19.5) years, 21 males and 29 females. Forty-two cases were located in limbs, 6 in pelvic ring and 2 in spine. All cases were examined by ultrasound, CT and MRI. One deputy director or chief physician of the ultrasound department and the radiology department mainly engaged in the musculoskeletal system. On the basis of CT, ultrasound and MRI were diagnosed respectively. All cases had pathological results of surgical resection or puncture biopsy. Results Among the 50 cases, 40 cases were diagnosed by pathology as recurrence and 10 cases as cicatrix . The sensitivity, specificity and accuracy of ultrasound diagnosis were 97.50%, 90.00% and 96.00% respectively. The sensitivity, specificity and accuracy of MRI were 92.50%, 40.00% and 82.00% respectively. The specificity and accuracy of ultrasound were higher than those of MRI, there were statistical differences in specificity and accuracy between ultrasound and MRI (P<0.05), the sensitivity was the same, and the difference was not statistically significant (P>0.05). The specificity of ultrasound in patients with internal fixation (85.71%) was higher than that of MRI (42.86%), and there were statistical differences in the specificity in patients with internal fixation between ultrasound and MRI (P<0.05). Conclusions Ultrasound can improve the diagnostic efficiency of bone tumor recurrence in the differential diagnosis of postoperative recurrence and scar formation of bone and soft tissue tumors, especially when the internal fixation has an impact on CT or magnetic resonance imaging, which is worthy of clinical promotion.
关键词
超声 /
骨肿瘤 /
瘢痕 /
复发 /
鉴别诊断
Key words
Ultrasonography /
Bone and soft tissue Neoplasms /
Cicatrix /
Recurrence /
Differential Diagnosis
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基金
广东省科技计划项目（2020A1414050028）
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