多发性骨髓瘤与骨转移瘤的X线及CT鉴别诊断

目的：为了提高对多发性骨髓瘤（ＭＭ）和骨转移瘤的影像学（Ｘ线，ＧＴ）的鉴别诊断水平，方法：收集经骨髓涂片或局部病灶活检病理证实的ＭＭ４４例。经手术、病理证实原发肿瘤并骨重破坏者７１例；骨破坏灶穿刺病理为骨转移瘤５例。将上述两组病例的Ｘ线及ＣＴ表现进行回顾性分析对比。结果：颅骨病变发生率ＭＭＯ ８５％，骨转移瘤为２１．４３％，两者比较Ｐ〈０．００５；下颌骨破坏ＭＭＯ ５０％，骨转移瘤为７．１４％，两

Differential diagnosis by imaging (X-ray and CT)between multiple myeloma and metastatic tumor in bone

Aim:To improve differential diagnosis by imaging(X-ray and CT) between multiple myeloma (MM) and metastatic tumor of bone.Methods:44 MM cases proved by pathological examination of bone marrow smear and focal lesion biopsy, and 71 cases of primary malignancy with osseous destruction as well as 5 cases of bony metastasis proved pathologically.Results:Incidence of cranial bone involvement in MM was 85.00% and that in osseous metastasis was 21.43%, P <0.005; 50 00% of MM versus 7 14% of osseous metastasis had mandibular destruction, P <0.01. The parts of vertebral appendix destruction of MM and bone metastasis were different: it occurred only in the pedicle in the former, while it occurred in other parts of the appendix besides the pedicle in the latter. In CT, expansive osseous destruction of MM appeared as a well-defined homogeneous soft tissue density with regular bony shell, and the expansive lesion only pressed contiguous structure, while the expansive osseous destruction in metastasis was mild with irregular mottled hyperdense residual or tumor bone within it ,and the expansive lesion invaded contiguous structure. Conclusion:Cranial bone destruction with multiple lesions and mandibular destruction are valuable signs for diagnosing MM. Vertebral destructive lesion involving pedicle and other parts of appendix besides pedicle and mottled hyperdensity within destructive lesion is in favor of diagnosing osseous metastasis.