X线平片及MRI诊断动脉瘤样骨囊肿的价值

目的评价X线平片与MRI检查对动脉瘤样骨囊肿(ABC)的诊断价值。方法回顾性分析15例经手术病理证实的ABC的影像学表现,15例均行X线检查,5例行MRI检查。结果(1)15中例ABC发生于长骨13例,肋骨及骨盆各1例;(2)皂泡状或吹气球样膨胀性骨质破坏:X线15例,MR5例;(3)病灶内骨小梁间隔或骨嵴:X线11例,MR4例;(4)局限性骨质硬化:X线10例,MR4例;(5)骨壳边缘不全病理骨折:X线3例,MR1例;(6)骨膜反应:X线1例;(7)软组织肿块:无;(8)病灶内单发或多发囊肿:MR4例;(9)液-液平面:MR1例。结论X线平片显示病变的整体形态有优势,结合MRI显示病变组织成分综合分析有利于提高ABC的诊断符合率。     

小儿维生素A慢性中毒的X线诊断（附32例报告）

本文报告经临床X线确诊的小儿维生素A慢性中毒(VA 中毒)32例。骨的X线表现是诊断本病的主要依据之一,主要有:(1)骨膜新骨形成以跖骨加尺骨或其他长骨为多;(2)胫骨上端内侧局限性骨膜下骨质吸收;(3)颅缝增宽及缝周骨质硬化。其他如骨质稀疏,骨干过度收缩,临时钙化带致密、增厚,骨骺或/和跗、腕骨环征等改变对确诊VA 中毒有一定参考价值,但缺乏特征性意义。探讨了VA 中毒的发生机理和骨改变的病理基础。     

原发性骨恶性纤维组织细胞瘤的X线表现

目的 :探讨原发性骨恶性纤维组织细胞瘤的X线表现。材料和方法 :回顾性分析 18例 (男 11例 ,女 7例。年龄16～ 71岁。)。经手术、病理证实的原发性骨恶性纤维组织细胞瘤的X线平片和CT表现。结果 :原发性骨恶性纤维组织细胞瘤好发于长骨干骺端或骨端。X线主要表现为溶骨性骨质破坏 ,部分病例呈膨胀性骨质破坏 ,软组织肿块或肿胀 ,骨膜反应少见 ,可合并病理性骨折。结论 :原发性骨恶性纤维组织细胞瘤X线表现缺乏特异性 ,但结合病史 ,在长骨干骺端或骨端溶骨性骨质破坏 ,无骨膜反应伴大的软组织肿块应考虑为原发性骨恶性纤维组织细胞瘤。     

骨原发性非何杰金淋巴瘤的X线表现与临床病理对照

目的　提高对PNHLB的X线表现与临床病理的认识。方法　报告 5例经手术病理证实的PNHLB的X线平片和临床病理所见 ,并作文献复习。结果　X线表现主要有 3种类型 :(1)浸润型骨质破坏 ,2例 ;(2 )溶骨性骨质破坏 ,2例 ;(3 )囊样骨质破坏 ,1例。 4例为B淋巴细胞型 ,1例为T淋巴细胞型。结论　该病少见 ,其特点为临床症状与X线表现两者不相一致 ,确诊依靠病理检查。     

长骨原发性动脉瘤样骨囊肿影像学表现

目的分析长骨原发性动脉瘤样骨囊肿(ABC)影像学表现,提高对其诊断及鉴别诊断水平。方法回顾性分析经手术、病理证实的24例长骨ABC的影像学资料,所有患者均行X线平片、CT及MRI检查,18例行MRI增强扫描。结果 X线表现为囊状膨胀性骨质破坏,10例病灶邻近骨质见连续骨膜反应,17例病灶内见粗细不一骨嵴;CT表现为病灶内缘分叶状改变,边缘锐利并不同程度硬化;MRI表现为囊性病灶,T_1WI序列呈等或稍低信号、T_2WI呈混杂稍高或高信号,病灶内及边缘可见分叶状或条索状低信号,20例可见液-液平面,增强扫描病灶边缘及内部分隔明显强化。结论长骨原发性动脉瘤样骨囊肿影像学表现典型,结合不同影像检查,不难诊断。     

长骨转移瘤的影像学诊断

目的探讨长骨转移瘤的影像学特点,提高诊断准确率。方法选择具有明确原发病史或病理证实的45例长骨转移瘤患者为研究对象,对其骨转移瘤病灶的X线、CT和MRI影像表现进行回顾性总结及分析。其中X线检查18例,CT检查26例,MR检查18例(部分患者同时做2种或3种检查)。结果 X线发现20处病灶的基本特点为呈不规则形、多发斑点虫蚀样破坏或类椭圆形透亮区。无论累及骨端还是累及骨干病变,均伴有周围骨质破坏,并部分相邻皮质伴有不连续条带状骨膜增生。CT发现27处病灶均呈溶骨性骨质破坏,破坏范围可单侧或四周,部分周围形成软组织肿块。累及骨干分为皮质型和常见型。MRI发现20处病灶表现为长T1长T2、压脂像为高信号。结论长骨转移瘤在影像学表现上具有多样化特点,具体在X线、CT、MRI表现各自具有其特征性。相对而言CT、MRI在敏感性方面显示出较显著优势,尤其是MRI在发现早期髓腔病变具有较高敏感性。但X线检查在骨膜反应方面则优于其他检查。若将X线、CT和MRI三者相结合进行综合分析验证,对于诊断长骨转移瘤和与骨其他病变相鉴别具有显著意义,可提高诊断准确率。     

早发型先天性骨梅毒的X线表现

目的分析早发型先天性骨梅毒的X线表现,提高对本病的认识。资料与方法搜集30例早发型先天性骨梅毒患儿的骨骼X线片和临床资料,分析其X线表现。结果早发型先天性骨梅毒的X线表现主要包括：(1)四肢长骨对称性的干骺端炎、骨膜炎和骨干炎。干骺端炎主要表现为临时钙化带增浓、模糊或增宽,骨质破坏和骨质缺损;骨膜炎主要表现为骨膜增厚;骨干炎表现为虫蚀状骨质破坏。30例中干骺端炎29例,骨膜炎12例,骨干炎3例。(2)其他如髂骨、锁骨、椎骨、肩胛骨和手足小骨均有干骺炎或骨皮质下透亮带和皮质虫蚀样破坏,以髂骨(10／23)和手足小骨(17／27)改变最为常见。(3)6例有四肢软组织肿胀,为对称性,其程度与骨破坏不一致。结论早发型先天性骨梅毒X线表现有一定特征性,可作为先天性梅毒的诊断手段之一,对诊断为先天性骨梅毒的患儿,应常规行四肢长骨及骨盆和手足等X线摄片。     

长骨骨干皮质型转移瘤的影像学诊断

目的探讨长骨骨干皮质型转移瘤的影像学表现特点。方法回顾性分析6例经临床及病理证实的位于长骨骨干的皮质型转移瘤的X线、CT及MRI检查资料。6例均摄患肢正侧位X线平片,其中CT检查2例,MR检查2例。结果 X线表现为长骨骨干骨皮质局限性偏心性骨质破坏,边界清晰。CT及MRI横断位示骨皮质呈"咬甜饼干"样骨质缺损,骨质破坏范围小于1/2周,边缘未见骨质增生、硬化,局部可见密度均匀的软组织肿块影,增强扫描强化明显。结论长骨骨干皮质型转移瘤具有一定的特征性影像学表现,结合其临床特点有助于诊断。     

儿童单灶性骨嗜酸性肉芽肿影像学特征分析

目的探讨儿童单灶性骨嗜酸性肉芽肿的影像学特征。方法回顾性分析2008年1月~2015年12月间25例经组织病理学诊断的儿童单灶性骨嗜酸性肉芽肿的影像学资料。结果男19例,女6例。年龄2~14岁,平均年龄6岁。长骨14例,脊柱6例,颅骨3例,锁骨1例,髂骨1例。长骨病变主要表现为骨质破坏、邻近骨皮质"扇贝样"压迹、骨膜反应和软组织肿胀或肿块。部分病变可见骨皮质钻孔样破坏、破坏区内死骨及周围硬化缘。椎体病变主要表现为椎体破坏、塌陷,呈"扁平椎"改变,部分可见椎旁软组织肿块,但椎间隙保持正常。颅骨病变主要表现为穿凿样骨质破坏,边界清晰,可见"斜坡征"。髂骨及锁骨病变缺乏特异性。病变在MRI多呈T_1WI等或稍低信号,T_2WI不均匀高信号。结论长骨的骨皮质"钻孔样"破坏、颅骨的"穿凿样"破坏及椎体的"扁平椎"是本病的特征性影像学征象。X线平片诊断价值有限,CT可清晰显示骨膜反应及骨质硬化,尤其是骨皮质细微的骨侵蚀。MR有助于显示X线及CT尚无异常表现的早期骨髓受累,并确定骨髓水肿及软组织病变范围。     

长骨皮质型骨转移瘤的X线诊断(附7例报告)

目的 探讨长骨皮质型骨转移瘤的Ｘ线诊断。材料与方法 回顾性分析７例经病理或随访证实的长骨皮质型转移瘤的Ｘ线表现，男５例，女２例，年龄５０～７０岁，平均６２岁。结果 ６例表现为“挖凿”样皮质缺损，１例呈边缘不清的虫蚀样皮质破坏。３例伴有明显骨膜反应，其中１例有Ｃｏｄｍａｎ三角。结论 长骨皮质型转移瘤的典型Ｘ线表现是“挖凿”样皮质破坏，可伴有明显骨膜反应，在诊断时需结合患者的年龄和病史以与原发性恶性骨     

Displaced humeral pathological fracture secondary to intraosseous hemangioma

Intraosseous hemangiomas are uncommon slow-growing benign bone tumors. Most of these lesions are located in the spine or skull and long bone location is rare. Here we present the case of a 63-year-old female with a pathological fracture of the left proximal humerus through an intraosseous hemangioma. Imaging features can be highly unspecific when these tumors are found in the long bones. In this case a pathological fracture obscured the diagnosis even further, prompting the need for tissue sampling to exclude an underlying malignancy.     

Polyostotic fibrous dysplasia (McCune-Albright) with rare multiple epiphyseal lesions in association with aneurysmal bone cyst and pathologic fracture

Fibrous dysplasia, including McCune-Albright syndrome, is a genetic, non-inheritable benign bone disorder that may involve a single or multiple bone, typically occurring in the diaphysis or the metaphysis of long bones. In very rare instances polyostotic fibrous dysplasia present involvement of the epiphysis in long bones. Aneurysmal bone cysts are benign, expansile, lytic bone lesions formed by cystic cavities containing blood, that may occur de novo or secondary to other lesions of bone, including fibrous dysplasia. We report a case of an 18-year-old female with polyostotic fibrous dysplasia (McCune-Albright syndrome) with diaphyseal and unusual multiple foci of epiphyseal involvement of long bones as well as in the patella, and a simultaneous aneurysmal bone cyst of the left femoral neck with pathologic fracture. This is the first report of a simultaneous aneurysmal bone cyst in a patient with polyostotic fibrous dysplasia (McCune-Albright syndrome) with involvement of diaphysis and epiphysis of long bones, highlighting that fibrous dysplasia should be included in the differential diagnosis of polyostotic tumors involving the diaphysis as well as the epiphysis. In patients with polyostotic fibrous dysplasia there should be an active search for lesions in the epiphysis.     

Fluid-fluid levels in bone and soft tissue tumors demonstrated by MR imaging]

Fluid-fluid levels in bone tumors have been described in aneurysmal bone cysts and other cystic tumors of bones and soft tissue tumors. We experienced three bone tumors (simple bone cyst, bone metastasis, and osteosarcoma) and three soft tissue tumors (fibrosarcoma, two cases of cavernous hemangioma) that showed fluid-fluid levels on MR, and investigated their cause. Causes included blood in the cystic spaces, hemorrhage in the tumor, the telangiectatic component of the osteosarcoma, and the cavernous component of the hemangioma. No specific diagnosis could be made based on the finding of fluid-fluid levels. We conclude that fluid-fluid levels on MR are rather nonspecific findings in bone and soft tissue tumors and that the diagnosis should be made on the basis of other radiological and clinical findings.     

骨盆骨巨细胞瘤影像特征分析

目的:分析骨盆骨巨细胞瘤X线平片、CT及MRI征象,探讨其影像特征及鉴别诊断要点。方法:分析总结经手术及病理证实的29例(包括7例复发)骨盆骨巨细胞瘤患者的X线平片、CT、MRI表现。结果:①X线平片表现:囊状骨质破坏15例,单纯溶骨性破坏8例,"多房性"骨质破坏6例。②CT表现:18例呈囊样膨胀性骨质破坏,11例呈单纯溶骨性破坏,未见骨膨胀扩张征象;增强扫描肿瘤实质部分均出现轻度至中度的强化。③MRI表现:6例MRT1WI上均呈等信号、低信号,T2WI上呈低信号、等信号、高混杂信号。结论:骨盆巨细胞瘤的影学表现为膨胀性溶骨破坏,与长骨巨细胞瘤比较除膨胀更为显著外,余无明显差异;骨盆骨巨细胞瘤诊断需综合运用X线平片、CT及MRI并与临床表现相结合,且能够提高骨盆骨巨细胞瘤诊断及鉴别诊断的准确性。     

“Lytic” lesions in autologous bone grafts: demonstration of medullary air pockets on post mortem computed tomography

Donor bone grafts are an important aspect of orthopaedic surgery. The use of plain film as a pathological screening tool before donor bone dispatch has revealed “lytic” lesions in proximal humeri. Donor demographics did not support the diagnosis of myeloma and subsequent computed tomography (CT) scans of these bones identified the lesions as air, not pathology. In total, 27 long bones were scanned and 100% (27/27 cases) exhibited air within the trabecular bone. Three distinct patterns were found: ovoid, linear/branching, and broad channel. A longitudinal course of CT scans was performed to identify at which stage air appeared within the bone. Pre-retrieval, preprocessing, and postprocessing scans revealed that air originated between the retrieval and preprocessing stages of donor bone preparation. There may be multiple aetiology of this phenomenon, including bone retrieval and natural decomposition.     

长骨转移瘤影像学特征分析

目的：加强对长骨转移瘤影像学的认识,提高诊断准确率。方法：回顾分析24例经病理或随访证实的长骨转移瘤的影像学表现,男10例,女14例,年龄21～80岁,平均52岁。结果：9例具有骨膜反应,其中1例为层状骨膜反应,1例为中断型骨膜反应伴骨皮质中断,其余7例为骨皮质增厚。结论：长骨转移瘤影像学表现多样化,但具有特征性。结合患者临床表现、检查和病理诊断,分析影像学资料,与原发性恶性骨肿瘤相鉴别,可提高诊断准确率。     

Tumors and space-occupying abnormalities of the skull calotte

Clinical and demographic data as well as the course of illness were analyzed in a retrospective study of 50 patients with a primary tumor or a malformation of the calvarial bones. The most frequent histological diagnosis was "eosinophilic granuloma of bone" (found in 42% of cases), followed by hemangioma, osteoma, dermoid, epidermoid and malignant tumors, and fibrous dysplasia. Local recurrence was observed in 1 patient with ossifying fibroma and 1 with a dermoid tumor, while further dissemination of illness was observed in 3 patients with "eosinophilic granuloma". In these cases, systemic drug therapy is needed. The necessity of an intensive search for further signs of illness and long follow-up periods in patients with primary localized histiocytosis X is stressed.     

颅面骨纤维异常增殖症的影像病理学表现

目的 探讨颅面骨纤维异常增殖症的影像表现和病理特点.方法 回顾性分析42例经手术病理证实的颅面骨纤维异常增殖症,对其影像学表现和病理特点进行对比分析.结果 42例中单发型35例,多骨型7例.磨砂玻璃状改变是骨纤维异常增殖症特征性CT表现,占CT检查患者的79.3%,纤维异常增殖症的病理成分纤维和纤维样组织,在磁共振的T_1WI和T_2WI上均表现为低信号;如病灶发生出血、坏死或囊变,T_2WI信号也随之发生改变.结论 CT和MRI扫描对颅面骨纤维异常增殖症的诊断具有重要意义.     

骨原发性恶性纤维组织细胞瘤的临床X线分析(附18例报告)

目的 :为提高骨原发性恶性纤维组织细胞瘤的临床 X线诊断水平。方法 :回顾性分析 18例经手术和病理证实的本病临床 X线所见。结果 :骨破坏大而症状轻 ,好发长骨干骺端或骨端。主要骨改变有散在性斑片状或大片溶骨性破坏 ;单囊或多囊状轻度膨胀性破坏 ;大片或囊状骨破坏区内伴有多发小孔状破坏。一些病例破坏区见条状或网状骨嵴或 /和斑点状钙化影 ,破坏缘不但模糊不清 ,而且有类似良性瘤的清楚或锐利的边缘 ,伴轻度硬化 ,无骨膜反应或有轻度反应。结论 :本病的 X线表现多样性 ,诊断需结合临床     

骨原发性恶性纤维组织细胞瘤影像诊断

目的探讨骨原发性恶性纤维组织细胞瘤(BMFH)影像表现及诊断要点。方法回顾性分析6例经病理确诊为BMFH的X线、CT及MRI表现。结果4例侵犯单骨,2例侵犯多骨。溶骨型4例,混合型2例。股骨下端3例,肱骨上端1例,楔骨1例,横突1例,共侵犯12个骨骼。6例均有骨及骨皮质明显破坏,以溶骨性破坏为主,2例病灶周围有轻度骨硬化。全部病例均有软组织肿块,巨大肿块2例,局限性肿块4例,1例肿块内可见散在小钙化影。全部病例未见骨膜反应,3例合并病理性骨折。结论原发性BMFH好发于长骨干骺端或骨端,多见于股骨下端及胫骨上端。虫蚀状或大片状溶骨性骨质破坏,巨大软组织肿块,无骨膜反应,是其影像学特点,诊断需密切结合临床和病理。