· pdf filewho 1. conventional os a osteoblastic type b chondroblastic type c fibroblastic...

44

Upload: vuongbao

Post on 13-Feb-2018

219 views

Category:

Documents


1 download

TRANSCRIPT

Page 1: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS
Page 2: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

1. osteosarcomas

2. chondrosarcoma

3. Ewing sarcoma

4. malignant fibrous histiocytoma

5. myeloma

6. malignant lymphoma of bone

Page 3: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

1.

geographic moth-eaten permeative

2.

Page 4: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

3.

Page 5: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

4.

Codman onion peel sunburst(spiculated)

Page 6: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

5.

Page 7: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

1. central OS

2. parosteal OS

3. periosteal OS

4. high-

grade surface OS

5. extra-osseous OS

6. multifocal OS

1. conventional OS

a osteoblastic type

b chondroblastic type

c fibroblastic type

2. telangiectatic

OS (TOS)

3. low grade

central OS

4. small cell OS

5. undifferentiated

6. secondary

Page 8: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

WHO

1. conventional OS

a osteoblastic type

b chondroblastic type

c fibroblastic type

2. telangiectatic OS (TOS)

3. small cell OS

4. low grade central OS

5. secondary

6. parosteal OS

7. periosteal OS

8. high-grade surface OS

Page 9: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

conventional central OS

1.

2.

50 100 1 ( 130-260 )

15 10 >20 >10 >

2 5

3.

3-4

Page 10: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

10

Sunburst

Codman

21817448

Page 11: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

MRIMRI

T1T1

T2T2

sunburstsunburst

Page 12: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

201Tl

viability

201Tl

Tumor-to-background ratio (TBR) (T)

(B) ROI TBR= T-B)/B

Alteration ratio TBR1

TBR2 alternation ratio(%)=(TBR1-TBR2)/TBR1 100

Page 13: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

grade2

Grade0 50-100%

Grade1 10-50%

Grade2 10

Grade3

2008/9/24

2008/9/5

2008/7/1

2008/7/11

Page 14: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

2006/10/12 2007/11/16

70 Paget OS21549176

Paget

50

OS 50%

MFH25%

Page 15: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

47

Page 16: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS
Page 17: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

parosteal OS

1.

(surface osteosarcoma)

2.

4% ( : =1:2) 20

30

3.

60%

Page 18: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

50

MRI

Page 19: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

telangiectatic OS

1.

X

(high-grade)

2.

2.6-4.3% : =3:2

3.

Page 20: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

70

21899495

Page 21: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

MRI

T1T2

ABC fluid-fluid

level

ABC

)

Page 22: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

chondrosarcoma

1. conventional CHS

a. primary CHS

b. ( ) periosteal CHS

c. secondary CHS

2. dedifferentiated CHS

3. mesenchymal CHS

4. clear-cell CHS

Page 23: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

chondrosarcoma

1.

2.

11-27%

30-50

3.

45%(

49% 36%) 25 8% 7% 5%

Page 24: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

60

erosion (endostealerosion)

Page 25: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

21727210

MRI

T1 T2

ring and arc

enhancement

endosteal scalloping

Page 26: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

2/3

T1WI

entraped fat entraped fat ( )

T2WI - - -

CE ring and arc ring and arc ring and arc

+

Yoo HJ. Eur Radiol 2009

Page 27: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS
Page 28: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

periosteal CHS

1.

2.

4% 30-40

3.

Page 29: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

40

erosion

Codman

MR

Page 30: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

secondary CHS

1.

2.

5-25

(Ollier ) 30-50

20 50

3.

Page 31: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

50

1.5-2cm1.5-2cm

Page 32: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

Ewing sarcoma

1.

PNET(primitive neuroectodermal tumor)

Ewing

2.

6-10% ( )

10 80%( 13 30 : =3:2

3.

CRP LDH 2/3

Page 33: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

4

Moth-eaten onion peel sunburst

Page 34: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

21886938

MRI

T1

T2

erosion

Page 35: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

malignant fibrous histiocytoma (MFH) of bone

1.

(striform pattern)

MFH 30%

2.

2 20 45 2

40

3.

7-9

30-45

Page 36: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

60

38

Page 37: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

MRIMRI

GCTGCT

21518408

Page 38: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

myeloma

1.

( )

(

) (

) 20

1 M

2.

35 60-70 40

3.

Ca

Page 39: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

60

(punched(punched out)out)

Page 40: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

21761922

MRIMRI

T1T1 T2T2

variegate patternvariegate pattern))

Page 41: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

primary malignant lymphoma of bone1.

9

non-Hodgkin B cell lymphoma

2.

3 20 50

2 40

3.

25

Page 42: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

30

(ivory vertebra )

Page 43: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

MRIMRI

T1T2T1T2

21440260

Page 44: · PDF fileWHO 1. conventional OS a osteoblastic type b chondroblastic type c fibroblastic type 2. telangiectatic OS (TOS) 3. small cell OS

1. osteosarcomas

2. chondrosarcoma

3. Ewing sarcoma

4. malignant fibrous histiocytoma

5. myeloma

6. malignant lymphoma of bone