The Invasive Signs In Benign Bone Lesions—Comparative Study Of MRI,CT And Radiography

Objective : To investigate the aggressive signs of benign bone lesions appearing on medical imaging and their impact on diagnosisMethod : Review 200 cases of benign bone lesions with aggressive signs, that were confirmed by pathology or clinical follow-up, while all patients underwent X-ray examination, 177 of them underwent CT plain scan, 103 cases underwent MRI scan, 89 cases perfomed all the three imaging modalitis. Count the aggressive signs, including the surrounding edema, abnormal soft tissue mass, discontinuous periosteal reaction, cortical disruption and pathological fractures, soft tissue calcification and ossification similar to tumor bone or residual bone. Count the consistent rate of diagnosis with pathology, and do statistical analysis.Results:Bone marrow and soft tissue edema were found in 9 cases of osteoblastoma, 6cases of chondroblastoma, 9 cases of osteoid osteoma, 17 cases of Langerhans cell histiocytosis, 18 cases of fatigue fracture, 25 cases of bone tuberculosis, 7 cases of atypical osteomyelitis. Cases of the abnormal soft tissue with mass effect, including 7cases of osteoblastomas, 1 case of chondroblastoma, 15 cases of Langerhans cell histiocytosis and 17 cases of bone tuberculosis. Discontinuous periosteal reaction were showed in 1 case of osteoid osteoma, 3 cases of Langerhans cell histiocytosis, 3 cases of fatigue fractures, 1 case of bone tuberculosis and 3 cases of atypical osteomyelitis.Disruption of cortical bone with pathological fracture were found in 7 cases of osteoblastomas, 3 cases of chondroblastoma, 4 cases of osteoid osteoma, 26 cases of Langerhans cell histiocytosis, 14 cases of fatigue fractures, 28 cases of bone tuberculosis and 4 cases of atypical osteomyelitis. Soft tissue calcification and ossification similar to tumor bone or residual bone were found in 1 case of bone blastoma, 2 cases of chondroblastoma, 2 cases of Langerhans cell histiocytosis and 5 cases of bone tuberculosis. For accuracy of differential diagnosis between the benign and malignant,and the consistent rate with pathology, CT is slightly better than MRI(P<0.05). The integrated application of the three imaging methods can significantly improve diagnostic accuracy(P<0.05).Conclusion : Many benign bone lesions can be associated with invasive signs, which make them difficult to diagnose. A comprehensive method combined with three kinds of imaging, is a simple and feasible way to avoid the misdiagnosis.