| Part I Retrospective analysis of clinic and epidemiology of osteosarcomaObjectiveA retrospective analysis was made on the clinical data of169cases of osteosarcoma from2005. Determine the age and location distribution and clinical feature of osteosarcoma, and to provide a reference to epidemiological investigation and imaging diagnosis.Materials and methods1. ObjectFrom Jan.2005to Dec.2012169cases were selected among the patients were diagnosed as osteosarcoma by Surgery and/or pathology. According to the WHO(2002), osteosarcoma of bone is classified into eight subtypes with distinct biologic behaviors and clinical outcomes:conventional, telangiectatic, small cell, low-grade central, secondary, parosteal, periosteal, and high-grade surface.2. Equipment and methodsSearch the clinical and pathologic data of osteosarcoma patients by Nan fang PACS system, from2005to2012.Divided the age into groups0～10,11～20,21～30,31～40, and elder than40. According to the WHO(2002), osteosarcoma of bone is classified into eight subtypes: conventional, telangiectatic, small cell, low-grade central, secondary, parosteal, periosteal, and high-grade surface.3. According to the location can be divided into femur, tibia, fibula, radius, pelvis, craniofacial bone, centrum, rib and soft tissue. Location was divided into two groups: nearby knee and diaphysis.Pathological methods:fix materials with4%methanal, select the pathological changes region and decalcification. Observe the specimen under microscope; carry through the immunohistochemical staining when it’s necessary.3. Statistical analysisAnalysis was carried on by using the SPSS13.0, significant level is5%,P-value less than5%was defined as had statistical significant. Compare the sex among different subtype and morbidity of nearby knee and diaphysis with chi-square test. Use the Wilcoxon rank sum test to compare the age of each subtype.ResultTotally169patients diagnosis by pathology,134of them were conventional osteosarcoma(about79.3%),1telangiectatic osteosarcoma(about0.6%),2small cell osteosarcoma(about1.2.%),20low-grade central osteosarcoma(about11.8%),4secondary osteosarcoma(about2.4%),7parosteal osteosarcoma(about4.1%), and only one patient is periosteal osteosarcoma(about0.6%).It is more common in males, with a male-to-female ratio of2.2:1. The age range is between5and64, median age was17, average age is20.9.Group0-10years had18cases,98cases were11-20years,24cases were21-30years,15cases were31-40years and14cases elder than40years.87cases of them had attacked femur(about51.5%),40tibia(about23.7%),10fibula,14radius,3pelvis,7craniofacial bone,3centrum,2rib and2soft tissue.107patients attacked nearby knee(about63.3%) and25(about14.8%) diaphysis. Statistical analysis result:①There were no statistical significance among sex and age in each subtype(P=0.568,0.226);②The incidence rate of nearby knee between conventional osteosarcoma and low-grade central osteosarcoma reach statistical significance(P=0.029);③There were statistical significance between conventional osteosarcoma and the other subtype in diaphysis(P=0.010).ConclusionThe great majority develop in age between10to20, its more commonly seen in males (male-to-female ratio2.2:1). The tumor has a predilection to the metaphyseal region of long tubular bone, especially around the knee joint. Another subtype is more likely attack diaphysis, but had a common age and sex.Conventional osteosarcoma is the most common subtype, secondly is low-grade central osteosarcoma. The average age of low-grade central osteosarcoma is elder than conventional osteosarcoma. Low-grade central osteosarcoma attack knee are not commonly known.The osteosarcoma has a wider position.Part Ⅱ A Contrast analysis the characteristics of Image with pathology results in each subtypeObjectiveIn order to realize the Imaging’s characteristics of each subtype and raise the level of imaging diagnosis, the X-ray, CT, and MRI image of167cases with osteosarcoma were analyzed retrospectively.Materials and methods1. ObjectFrom Jan.2005to Dec.2012167cases were selected among the patients were diagnosed as osteosarcoma by Surgery and/or pathology and had imaging information. All of them had X-ray plain film,20patients underwent CT scan and MRI examinations were performed in83cases(X-ray+CT20cases, X-ray +CT+MRI7cases, X-ray+MRI83cases).2. Equipment and methodsX-ray examination:SIEMENS Aristos MX digital X-ray machine underwent frontal and lateral X-ray films when exam all four limbs and vertebra, craniofacial bone, pelvis and rib implement lateral X-ray films. CT examination:GE Lightspeed16multi-detector helical CT, non-ionic contract agent was iohexol(300mgI/ml). MRI examination:GE3.0T MRI scanner and SIEMENS1.5T MRI machine. Choose the coils according to lesions. Contract materials were Gd-DTPA.The images were diagnosis by three experienced doctor form radiology department. The data were blinded. If there were any opinions differ in sign observed, the verdict given by the superior doctor. The observation of X-ray and CT include bony destruction, soft tissue mass, tumor bone and periosteal reaction. Divided the bony destruction into groups:osteolytic, osteogenic and mixed. Tumor bone was divided in ivory-like, cotton-like and needle-like. Periosteal reactions include Codman triangle, laminated, and spiculated. CT scans assist separate the indicator as a supplement. MRI observation:medullary cavity invasion, cortex interruption, soft tissue mass and edema around the lesion. Compare with the signal intensity of muscle, MR signal intensity divided into hypo-or iso-intensity, iso intense signal intensity and iso-or hyper intensity.3. Statistical analysisAnalysis was carried on by using the SPSS13.0, significant level is5%, P-value less than5%was defined as had statistical significant. Compare the sign among different subtype with chi-square test.ResultX-ray and CT:conventional osteosarcoma usually perform mixed bony destruction,77.3%cases had soft tissue mass, cotton-like tumor bone were found in almost72.0%patients, many cases had one or more periosteal reaction,the most common is Codman triangle, only22.9%cases without periosteal reaction. Low-grade central osteosarcoma usually perform osteogenic bony destruction, only40.0% patients had soft tissue mass, Low-grade central osteosarcoma had a similar rate of three types of tumor bone. Periosteal reaction were found in42.9%cases, laminated were dominant in these three types.MRI:all of the patients in conventional osteosarcoma and low-grade central osteosarcoma had medullary cavity invasion, also in another subtypes except parosteal osteosarcoma. Most of the patients had found cortex interruption and edema around the lesion.27cases (32.5%) showed hypo-or iso-intensity on T1-weighted images,37cases (44.6%) were isointense intensity and18cases (21.7%) were iso-or hyper intensity.78cases (94.0%) of them were heterogeneous. On T2-weighted images,9cases (10.8%) were hypo-or iso-intensity,2(2.4%) were isointense intensity and72cases (86.7%) were iso-or hyper intensity, all of them showed heterogeneous.76patients had enhance examination, enhanced scan began5-10mins after plain scan. Enhanced image showed heterogeneous enhancement with central non-enhancing portions, some patients showed slightly enhancement.Statistical analysis result:X-ray and CT,①The incidence rate of soft tissue mass between conventional osteosarcoma and low-grade central osteosarcoma reach statistical significance (P=0.002);②There were statistical significance among Codman triangle between conventional osteosarcoma and low-grade central osteosarcoma (P<0.001), so do conventional osteosarcoma and another subtypes (P=0.029);③There were no statistical significance in bony destruction(osteolytic P=0.559, osteogenic P=0.266and mixed P=0.787), tumor bone (ivory-like P=0.371, cotton-like P=0.396,needle-like P=0.355), laminated (P=0.075)and speculated(P=0.532) periosteal reaction.MRI:There were statistical significance in soft tissue mass between conventional osteosarcoma and low-grade central osteosarcoma. ConclusionConventional osteosarcoma usually perform mixed bony destruction and cotton-like tumor bone, the incidence rate of soft tissue mass and Codman triangle were higher than low-grade central osteosarcoma.Low-grade central osteosarcoma showed osteogenic bony destruction, with cotton-like tumor bone and laminated periosteal reaction. Parosteal osteosarcoma usually showed edema around the lesions without medullary cavity invasion.Part III imaging and clinical analysis of osteosarcoma in diaphysis ObjectiveSummarize the imaging characteristic and pathological subtypes of osteosarcoma in diaphysis, guide the clinical work and raise the level of imaging diagnosis.Materials and methods1. ObjectFrom Jan.2005to Dec.201225cases were selected among the patients were diagnosed as diaphysis osteosarcoma by Surgery and/or pathology. Retrospective analysis was carried out in these25patients. According to the WHO(2002),there were15cases conventional,1small cell,7low-grade central,2parosteal, periosteal.23of them had X-ray plain film, MRI examination were performed in13cases(X-ray+CT1case, X-ray+CT+MRI1case, X-ray+MRI13cases)2. Equipment and methodsSearch the clinical and pathologic data as PART I.X-ray examination,imaging index and estimation as PART II. And add a index in survey the lesion on MRI, it can be done on X-ray and CT when without MRI.3. Statistical analysis Analysis was carried on by using the SPSS13.0, significant level is5%,P-value less than5%was defined as had statistical significant. Ues the Wilcoxon rank sum test to compare the age of each subtype.Compare the sign among different subtype with chi-square test.ResultIn the totally25patients,17were males with a male-to-female ratio of2.13:1. The age range is between5and58, median age was16, and average age is20.56. The age between10-25were10. It is more common in femur (about68.0%),60.0%of them were conventiona,28.0%of them were low-grade central.The length range is between4.9cm and34.0cm, the average is13.0cm.X-ray and CT:The incidence rate of bony destruction was approximate in diaphysis osteosarcoma. There were osteolytic and mixed bony destruction in non diaphysis cases.56.5%cases had soft tissue mass compare with74.3%in non backone ones. All of the patients showed cotton-like tumor bone. There were56.5%cases showed laminated periosteal reaction but non diaphysis cases only28.5%.MRI:2cases (2/13) showed hypo-or iso-intensity on T1-weighted images,10cases (10/13) were isointense intensity and only one case (1/13) was iso-or hyper intensity.12cases of them were heterogeneous. On T2-weighted images, only one case (1/13) were hypo-or iso-intensity and isointense intensity.There were11cases (11/13) were iso-or hyper intensity, all of them showed heterogeneous. Enhanced scan began5-10mins after plain scan. Enhanced image showed heterogeneous enhancement with central non-enhancing portions, some patients showed slightly enhancement.Statistical analysis result:①The incidence rate of laminated periosteal reaction between diaphysis and non diaphysis reach statistical significance (P=0.008);②There were no statistical significance among the incidence rate of bony destruction, tumor bone and soft tissue mass between diaphysis and non diaphysi (P=0.560)ConclusionThe incidence rate of diaphysis osteosarcoma was14.8%, usually attack femur, male-dominate and the age was elder.The lesion had a wide confines, many of them were longer than10cm.Imaging were related to pathology.X-ray showed laminated periosteal reaction and cotton-like tumor bone, soft tissue mass were unusual. MRI showed isointense intensity on T1-weighted images, and heterogeneously high signal intensity on T2-weighted image. Cortex interruption were uncommon, majority cases were in the medullary cavity and destroy along the macroaxis. |
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