本站原创【中图分类号】R738.1【文献标识码】A【文章编号】1004-7484（2012）12-0482-01
骨癌是指骨骼系统与其他器官一样会罹患来自任何组织成份肿瘤或来自其他器官的转移性病变.犯及骨骼的肿瘤,可发生于骨细胞、骨骼的造血成份,软骨以及纤维性或滑膜成份.多见于中老年人,男性多于女性.近年来发病率有增多趋势[1],并且发病年龄提前.其临床表现十分复杂,容易误诊,误诊率高达69..11%[2].为进一步加深对本病的认识,提高诊断率,现将我院自2007年来收集的经骨髓涂片和手术病理证实的30例骨癌患者的放射科做一回顾性分析.
1资料与方法
1.1一般资料20例患者中男19例,女11例,年龄37～69岁,平均58岁.主要临床症状：骨痛18例,其中腰背疼痛12例；贫血14例；发热17例；乏力11例；病理性骨折7例.骨穿可见原始细胞增多,血常规检查红细胞减少9例,血红蛋白减少10例,血沉增快16例,白细胞增高5例,尿酸增高6例,碱性磷酸酶升高6例,免疫球蛋白电泳IgG升高13例,IgA升高4例,IgD升高2例,IgM升高1例,尿蛋白阳性14例,尿本..周氏蛋白阳性9例.
1.2放射科检查..所有病例全部摄取头颅+脊柱正侧位+骨盆+胸部正位X线平片.同时选择性摄有其他部分：肩关节11例,胸骨斜位6例,肱骨9例,股骨7例；12例进行CT检查；10例进行MRT检查.
2结果
2.1X线表现..30例均进行了X线检查,各种溶骨性破坏发生在头颅骨15例,胸椎13例,腰椎16例,骨盆7例,肋骨9例,其中4例为膨胀性,肩胛骨2例,锁骨、肱骨及股骨各2
例,胸骨2例,长骨病理骨折1例,破坏边缘有少许骨硬化,并见软组织肿块.
2.2CT表现进行CT检查17例,共25个部位,20个部位表现骨质破坏或脊椎骨质疏松,部分伴压缩骨折,表现大致与X线平片相同,但观察累及范围优于X线平片.
2.3MRI表现10例进行了MRI检查,10例患者示明显异常信号改变,多数病变呈长T1、长T2信号.按Stabler等分型：弥漫型2例,灶型3例,弥漫加灶型4例,“盐和胡椒”型1例.其中,同时侵犯椎体和附件3例,硬脊膜受累变厚3例,增强后病变不均匀增强和硬脊膜均匀增强1例.
3讨论
骨癌中的骨髓瘤起源于红骨髓,突出的病变特征为骨髓内大量浆细胞增生,占骨髓腔内细胞总数15%～19%.临床表现多样化,起病隐袭,多数病程缓慢,在临床上和实验室检查异常怀疑有骨癌,应及时多部位做放射检查,放射检查在骨癌分期、监测治疗反应、探测复发和评估并发症中起了重大作用.
3.1骨癌的放射科检查特征骨癌的X线表现复杂多样,可为全身性的骨质疏松,单一骨质损害、多发的溶骨性病变及骨质硬化,以溶骨性损害及骨质疏松发生率最高,其中多数表现为在骨质疏松的基础上出现多发的点片状骨密度减低区及边界较清晰的虫蚀样和穿凿样骨破坏.颅骨X线平片对显示病灶较敏感,其他部位的X线征象缺乏特征性改变,易被误诊为类风湿或风湿性骨关节病而延误治疗.CT表现与X线片表现相似,对检出不规则骨及中轴骨的病变明显优于X线片,因CT具有较高的密度分辨率,且为横断成像,故能发现较小的不典型病灶,可作为X线平片的补充.骨癌脊椎CT上表现为多发性圆形或卵圆形或不规则形破坏,呈皂泡样或蜂窝样或大片样或空洞样,残留骨小梁不规则增粗,部分骨皮质中断伴椎旁软组织肿块,部分病例可同时侵犯附件.临床可疑或确诊骨髓瘤,X线和CT未发现时行MRI检查,MRI能敏感的发现骨髓病变而成为最佳的影像检查方法[3],在骨质结构破坏前显示出骨髓的广泛性浸润[4],病灶在T1WI上表现为骨髓脂肪高信号的衬托下界面清晰低信号,T2WI上病灶不清晰,T2WI脂肪抑制呈高信号,典型者呈“椒盐样”..征象.
32骨癌的并发症与误诊..在骨癌的并发症中,以贫血最多,而且以中重度贫血为主,其次为低白蛋白血症、高球蛋白血症、高尿酸症、肾脏损害、肺部感染等.而在误诊的疾病中按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系统统计,以骨骼肌肉系统疾病误诊最常见,其次为血液、呼吸、心脑血管、肾脏等.要提高多发性骨髓的正确诊断率,应首先提高医生对本病的认识,临床怀疑多发性骨髓的病例,应及时做多部位放射检查,以进一步确定诊断.