肩胛骨恶性骨肿瘤的影像分析

目的:总结肩胛骨恶性骨肿瘤的类型和影像表现。材料与方法:收集2006年4月到2018年12月18例（男女比14:4，平均年龄47岁）手术病理证实的肩胛骨恶性骨肿瘤的术前X线、CT及MRI资料进行回顾性分析。结果:肩胛骨恶性骨肿瘤以转移瘤多见（9/18，50％），大多是肺腺癌转移，肝胆系统的肿瘤也可转移至此部位。尤文肉瘤在此部位也比较好发（3/18），小的骨破坏灶伴骨膜反应和钙化、巨大软组织肿块是常见表现。其次是孤立性浆细胞瘤（2/18），部分病灶进展缓慢，膨胀生长，呈低度恶性过程。磁共振T2WI及增强扫描有助于区分软骨肉瘤和骨肉瘤。存在放射状骨膜反应时，除了骨肉瘤、尤文肉瘤、软骨肉瘤，上皮样血管内皮瘤也应考虑。结论:X线、CT、MRI综合运用可以提高肩胛骨恶性骨肿瘤的术前诊断率。 

Imaging Analysis of Malignant Bone Tumor in Scapula

Objective: To summarize the types and imaging features of malignant bone tumors of scapula. Materials and methods: From April 2006 to December 2018, the preoperative X-ray and CT, MRI data of 18 cases of malignant scapular tumors confirmed by surgical pathology (male to female ratio: 14: 4, average age: 47 years old) were collected for retrospective analysis. Results: Metastatic tumors were more common in scapular malignant bone tumors (9/18, 50%), most of which were metastatic from lung adenocarcinoma. Ewing's sarcoma was also more common in this area (3/18), with small bone lesions with periosteal reaction and calcification, and large soft tissue masses are common manifestation. The second was solitary plasma cell tumor (2/18). Some of the lesions developed slowly and expanded, showing a low-grade malignant process. Magnetic resonance imaging (T2WI) and contrast-enhanced MRI are helpful to distinguish chondrosarcoma from osteosarcoma. In addition to osteosarcoma, Ewing's sarcoma, chondrosarcoma, epithelioid angioendothelioma should also be considered in the presence of radial periosteal reaction. Conclusion: Combined use of X-ray and CT, MRI can improve the preoperative diagnosis rate of scapular malignant tumor.