Value of diffusion weighted imaging in preosurgical planning of pelvic malignant bone tumors
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摘要:目的
探讨弥散加权成像(DWI)在骨盆常见恶性骨肿瘤术前规划中的应用价值。
方法回顾性分析2014年12月—2021年10月收治的经病理证实的35例骨盆软骨肉瘤和骨肉瘤患者的临床、影像和病理学资料。13例骨肉瘤患者纳入骨肉瘤组, 22例软骨肉瘤患者纳入软骨肉瘤组。通过配准CT与对应DWI图像, 借助Medraw软件进行肿瘤边界勾画，形成骨盆肿瘤三维模型报告，辅助临床设计手术截骨距离方案。记录软骨肉瘤组和骨肉瘤组患者的磁共振成像(MRI)表观弥散系数(ADC)值、术后病理切缘结果及短期影像随访复发率情况。
结果35例患者中, 26例累及髂骨, 16例累及髋臼, 8例髂骨单独受累, 15例同时累及3个或以上部位。软骨肉瘤组的平均ADC值为(1.21±0.17), 高于骨肉瘤组的(0.97±0.21), 差异有统计学意义(P < 0.000 1)。所有病例肿瘤切除骨边缘均为阴性, 6个月内临床随访均无复发。
结论DWI对骨盆恶性骨肿瘤边界判断有一定帮助，基于DWI和ADC值的术前规划截骨范围有助于设计临床个性化手术方案。
Abstract:ObjectiveTo explore the value of diffusion weighted imaging (DWI) in presurgical planning of pelvic bone neoplasms.
MethodsThe clinical, imaging and pathological data of patients pathologically confirmed as pelvic chondrosarcoma and osteosarcoma from December 2014 to October 2021 were retrospectively analyzed. Thirteen patients with osteosarcoma and 22 patients with chondrosarcoma were included in the osteosarcoma group and chondrosarcoma group. Through the registration of CT and corresponding DWI images, the tumor boundary was drawn by the Medraw software to form a three-dimensional pelvis model to design the osteotomy distance. The magnetic resonance imaging (MRI) apparent diffusion coefficient (ADC), postoperative pathological results and short-term recurrence rate of two groups were compared.
ResultsOf the 35 patients, 26 involved the ilium and 16 involved the acetabulum, of which 8 involved the ilium alone and 15 involved three or more sites simultaneously. The average ADC value in chondrosarcoma group was (1.21±0.17), which was higher than (0.97±0.21) in the osteosarcoma group (P < 0.000 1). The resection margins of the tumor were negative in all cases, and there was no recurrence within 6 months of clinical follow-up.
ConclusionDWI is helpful to judge the pelvic malignant bone tumors boundaries, and the presurgical planning of osteotomy range based on DWI and ADC value can help individualized operation design.
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图 2 影像辅助规划手术过程
A: 骨盆肿瘤三维模型; B: 基于CT和MRI配准的融合重建肿瘤模型(图中蓝线为术前模拟10、20、25、30 mm截骨范围); C: 假体和骨盆模型; D: 术后骨盆平片; E: 术后6个月的MRI图。
表 1 2组患者基本临床信息比较(x±s)[n(%)]
临床特征 骨肉瘤组(n=13) 软骨肉瘤组(n=22) 年龄/岁 45.08±18.63 51.64±13.26 男 8(61.54) 17(77.27) 女 5(38.46) 5(22.73) 肿瘤最大直径/cm 13.85±5.01 13.75±5.81 ADC值/(×10-3 mm2/s) 0.97±0.21* 1.21±0.17 术后随访原位复发 0 0 ADC: MRI表观弥散系数。与软骨肉瘤组比较, * P＜0.000 1。 
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