examination of giant cell tumor of bone, diagnosis of giant cell tumor of bone
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Common examinations for giant cell tumor of bone
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- The bones and joints of the limbs and the flat bones of the upper limbs and lower limbs - used to confirm fractures...
- Bone and joint MRI joint nuclear medicine bone and joint MRI examination...
- Bone joints and soft tissue CT bone other - bone joints and soft group...
1. X-ray inspection
The lesions are mostly located at the end of the long bone (the epiphysis). Shows central or eccentric osteolytic destruction, and invades the metaphysis. Extending to the joint can completely destroy the subchondral bone. Under normal circumstances, the boundary of the lesion is clear, showing a swelling change. There is generally a thin reactive bone shell around the lesion, and the inner wall of the bone shell may have bone ridges protruding from the lesion, forming the so-called "lobular" or "soap bubble-like" changes under X-ray. In some cases, there is no swelling change. The tumor can destroy or break through the cortical bone, enter the surrounding soft tissue, and form a mass in the soft tissue. Periosteum reaction is generally absent, and it is a different matter when there is a pathological fracture. Sometimes it can be accompanied by osteoporosis of bone. Giant cell tumors of bone have no calcified tumor matrix and are often accompanied by pathological fractures. Giant cell tumors of bone located in the sacrum are often eccentric and often involve one side of the sacroiliac joint, while chordomas are often located in the center of the sacrum. The giant cell tumor of bone located in the spine easily involves the vertebral body and pedicle, and the kyphosis is secondary to the collapse of the vertebral body. Involving the anterior structure of the spine is a characteristic of giant cell tumors of bone, while aneurysmal bone cysts and osteoblastomas often destroy the posterior structure of the spine. In patients with unclosed epiphyseal plates, osteolytic destruction occurs at the metaphysis, and then passes through the epiphyseal plate to involve the epiphysis. X-ray film can show its general characteristics, but it is still not enough to confirm the diagnosis.
Occasionally occurs in the bony process, such as large and small tuberosity. Flat bones such as the pelvis and shoulder blades are rare. There are also reports that giant cell tumors of bone occur in the hands and feet. The spine (except the sacrum) is also rare.
Giant cell tumors of bone all show osteolytic destruction and have a wide transition zone. The cortical bone in the diseased area often swells and becomes thinner. The residual bone crest in the lesion showed a separation phenomenon on the X-ray. Tumors can also invade surrounding soft tissues.
The X-ray findings of some aggressive osteolytic lesions resemble giant cell tumors of bone, such as aneurysmal bone cysts and brown tumors in hyperthyroidism.
2. CT examination
CT examination exceeds X-ray and tomography in determining the boundary of the tumor. The tumor showed solid changes, and the CT value was similar to that of muscle. Sometimes the tumor contains a cyst, but the fluid level is rarely seen like an aneurysmal bone cyst. The reactive bone shell is different from normal bone cortex and has less calcification. CT examination is very helpful to clarify the relationship with articular cartilage and joint cavity and the extent of tumor invasion of surrounding soft tissues. The new type of double-helical CT can be obtained by intravenous injection of contrast agent. Reconstruction of various levels shows the blood vessels in the tumor, which can be used for arteriography.
3. Magnetic resonance imaging (MRI)
Magnetic resonance imaging is the best imaging method for giant cell tumor of bone. It has high-quality contrast and resolution. The tumor exhibits a low intensity signal during the longitudinal relaxation time (T1-weighted image). In the horizontal
Directional relaxation time (T2-weighted image) appears as a high-intensity signal. Therefore, it is best to use T1-weighted images to observe intramedullary lesions, and to use T2-weighted images when observing extracortical lesions. MRI has an advantage in showing any extra-skeletal invasion and joint involvement, while CT has characteristics for observing bone cortical destruction and reactive bone shell. MRI and CT are very useful for early detection of tumor recurrence. The vast majority of lesions consist of a mixture of viable tissues and necrotic tissues in varying numbers. The MRI signal of such lesions is not uniform, and the high signal and low signal areas exist alternately.
The spread of subchondral lesions to adjacent joints usually occurs at the start and end points of the intra-articular ligaments, and the more common is the cruciate ligament of the knee joint. Spreading directly into the joints through articular cartilage is relatively rare, but it can happen. The tendency of giant cell tumor to directly invade and destroy articular cartilage is not unique to it, but it is more common than any other tumors (including malignant tumors). It is not common to spread pathological fractures into the joints, but it can happen. Therefore, when a pathological fracture occurs, it must be checked for intra-articular spread. Observing the entire lesion specimen, its appearance is very diverse. Some lesions are completely composed of soft, rich blood supply and reddish-brown fragile tissue. Due to the high water content of this kind of lesion, it appears as a high signal with uniform texture on MRI.
Other lesions are mainly composed of harder yellow cheese-like tissue or spongy necrotic tissue, with almost no vascular tissue. These areas are composed of necrotic tumor tissue and large, fat-filled tissue cells.
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