长期血液透析继发棕色瘤的影像学表现

目的探讨长期血透继发甲状旁腺功能亢进所致棕色瘤的临床特点、影像学征象及其鉴别诊断,进一步提高对该病的认识。方法回顾分析经病理证实的11例长期血透继发甲旁亢所致棕色瘤的临床、实验室特点、病理及影像学特征。结果11例中血透时间2-15年,平均7.5年,甲状旁腺激素(PTH)及碱性磷酸酶(ALP)明显升高。多骨受累多见(10例多发,1例单发,共21处病灶)。全身骨质弥漫骨质疏松(9例)或骨质硬化(2例)。膨胀性(16处)或溶骨性(3处)骨质破坏,边缘硬化边(9处),骨质破坏内部钙化或骨化(15处),伴软组织肿块(4处),增强扫描明显强化。发生在颅骨者(2处),表现为弥漫骨质密度增高。结论继发甲旁亢所致棕色瘤多有明确病史,实验室具有相对特异改变,影像学表现为弥漫骨质疏松或硬化,累及中轴骨较多见,骨质破坏内部钙化/骨化和明显强化的软组织肿块是较有特异性的影像学征象。

Imaging Findings of Brown Tumor Secondary to Long-term Hemodialysis

Objective To discuss the clinical characteristics, imaging findings and differential diagnosis of brown tumor secondary to Long-term hemodialysis. And to further improve the understanding of the disease. Methods 11 cases of brown tumors were proved by surgical or biopsy pathology. The clinical and pathological features and imaging manifestations were analyzed retrospectively. Results In the 11 cases, the blood dialysis duration 2-15 years, average 7.5 years. Serum alkaline phosphatase and Parathyroid hormone can increased significantly. Of the 11 cases (total of 21 lesions), 10 cases were multi-part bone involved.9 of 11 patients for osteoporosis and 2 cases were osteosclerosis.19 lesions had bone destruction, 16 lesions showed expansive bone destruction, 3 showed soluble bone destruction, 9 lesions had harden edge. 15 lesions in bone destruction had calcification or ossification internal. 4 cases with soft tissue mass, enhanced significantly can be found in some cases. 2 lesions occured in the skull, bone density increased and the plate edge blur. Conclusion Brown tumor secondary to Long-term hemodialysis, there had clear medical history, parathyroid hormone and alkaline phosphatase increased significantly. Diffuse osteoporosis or osteosclerosis. More involved axial skeleton than primary hyperparathyroidism. In bone destruction area had calcifications/ossification and soft tissue significantly improved. Those characteristic features were important to help for the diagnosis of the"brown tumor".