脊柱动脉瘤样骨囊肿的CT、MRI诊断

目的：分析脊柱动脉瘤样骨囊肿的CT、MRI表现,提高对该病的CT、MRI诊断和鉴别诊断。方法：回顾性分析经临床病理证实的12例脊柱动脉瘤样骨囊肿的CT、MRI表现。结果：12例脊柱动脉瘤样骨囊肿患者中颈椎3例,胸椎6例,腰椎3例;单独椎体侵犯1例,单发于椎板2例,同时累及椎体及附件者9例。CT表现局限性囊状或膨胀性骨质破坏,边界清晰,内可见分房骨嵴影,4例可见内部多发液一液平面影。MRI示膨胀性溶骨性破坏灶周围可见低信号影包绕,病灶内呈多发分房状改变,T1WI呈不均匀低／等信号;T2WI呈数个大小不等的高／等信号囊腔,10例可见不同信号强度的液一液平面影。增强扫描可见囊腔周缘明显强化,腔内出血和液体无强化。结论：脊柱动脉瘤样骨囊肿CT、MRI表现具有一定的特征性,能够做出正确诊断。     

长骨纤维结构不良的CT及MRI诊断分析

目的探讨CT及MRI对长骨纤维结构不良的诊断及鉴别诊断价值。方法回顾性分析经病理证实的21例长骨纤维结构不良患者。所有患者均行CT平扫,MRI平扫及增强扫描19例。结果单骨型20例,其中股骨11例,胫骨4例,肱骨3例,尺骨及腓骨各1例;多骨型1例,同时累及同侧股骨及胫骨。CT表现呈磨玻璃样改变11例,囊状膨胀透亮改变8例,丝瓜络样改变2例。对照CT,呈磨玻璃样改变时MRI上T1WI呈等、稍低信号,T2WI呈不均匀等、稍高信号;呈囊状膨胀透亮改变时,T1WI呈低信号,T2WI呈明亮高信号;呈丝瓜络样改变时,T1WI呈不均匀稍低信号,T2WI呈不均匀稍高信号;增强后呈不同程度边缘或片状不均匀强化。结论 CT可显示长骨纤维结构不良的病变范围及细节等,MRI有助于反映病变组织成分,CT结合MRI在纤维结构不良的诊断及鉴别诊断中有重要价值。     

实性动脉瘤样骨囊肿的影像学表现

目的 探讨实性动脉瘤样骨囊肿的影像学表现,提高本病的鉴别诊断能力。资料与方法 回顾性分析2007年1月—2019年1月空军军医大学西京医院经术后病理证实的5例实性动脉瘤样骨囊肿的X线、CT、MRI资料,分析病灶所在母骨位置、病灶大小形态、边缘、肿瘤基质和周围软组织改变等影像学征象。结果 5例均为女性,病灶发生于胫骨2例、股骨1例、寰椎椎弓1例、髋臼周围1例,均偏心性位于母骨。病灶大小4.0～17.0 cm,均为大片状地图样、溶骨性破坏,膨胀性较轻。病灶边界清晰3例、模糊2例,有窄且长短不等的硬化缘。所有病灶骨皮质变薄、壳样改变,局部断裂、筛孔状改变或大段缺失。1例周围有软组织肿块。所有病变均无骨膜反应。2例病灶周围广泛水肿。CT表现：2例病灶内部呈等或略低于肌肉密度,无基质矿化。MRI表现：2例病灶内部T1WI信号略高于肌肉,T2WI呈均匀高信号,且有点状更高信号。所有病例均无病理性骨折。结论 实性动脉瘤样骨囊肿青年女性好发。病灶呈轻度膨胀性、溶骨性改变,有窄硬化缘,CT呈均匀等低密度,MRI呈混杂信号,可突破骨皮质形成软组织肿块,邻近骨髓与软组织明显水肿。     

肝胆管囊腺癌影像学表现

目的 探讨肝胆管囊腺癌的CT、MRI及B超表现,提高其诊断准确率.方法 回顾性分析18例经病理证实的肝胆管囊腺癌患者,螺旋CT检查6例、MRI检查5例,B超检查7例.结果 18例肝胆管囊腺癌患者中多囊性病灶2例,16例为单囊性病灶.CT平扫及MRI T1WI均表现为囊性占位,囊内可见分隔和乳头样、条状实性突起,囊壁不均匀增厚,T2WI病灶呈高信号为主,囊内分隔及乳头样、条状实性突起呈低信号,增强后动脉期囊壁、分隔及实性部分轻度强化,门脉期进一步强化,延迟期减退但仍有强化.B超均表现肝内液性为主的囊实性混合回声团块,边界较模糊,边缘高低不平,囊内有棉絮状或乳头状赘生物.结论 平扫加动态增强CT、MRI及B超能够一定程度反映肝胆管囊腺癌的影像学特点,对于提高该疾病的诊断具有一定参考价值.     

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。     

动脉瘤样骨囊肿的影像和病理学表现

目的:分析动脉瘤样骨囊肿(aneuriysmal bone cyst,ABC)的影像学及病理学特点,以期提高ABC的诊断水平。方法:回顾性分析32例经病理证实的动脉瘤样骨囊肿的影像学表现,全部病例中行X线检查20例,行CT检查17例,行MRI检查14例,部分患者在X线检查后进行了CT或MRI检查。结果:病灶分布于四肢长骨18例,脊椎8例、骨盆4例、下颌骨1例、跟骨1例;在X线和CT表现为上ABC表现为偏心性和膨胀性骨质破坏,MRI表现为多囊性病灶,T1WI呈低信号,T2WI呈高信号;病理均表现为含血囊腔及结缔组织性的间隔。结论:动脉瘤样骨囊肿有其特征性影像学表现,普通X线检查是最基本的首选检查方法,CT和MRI在显示动脉瘤样骨囊肿病灶内部结构和鉴别诊断上具有优势,综合影像学检查能提高动脉瘤样骨囊肿诊断符合率。     

颅骨少见良性病变的影像诊断分析

【摘要】 目的：探讨CT及MRI对颅骨良性病变的诊断价值。方法：回顾性分析13例以骨质破坏为主的颅骨良性病变的CT及MRI表现,并与其病理表现进行对照分析。结果:13例中骨纤维结构不良6例,主要CT表现为局限性小病灶（5例）多呈磨玻璃密度,弥漫性病灶（1例）可见磨玻璃密度及丝瓜络样改变;主要MRI表现为病灶在T1WI及T2WI上均以低信号为主;骨化性纤维瘤3例,主要CT表现为肿瘤呈膨胀性生长,骨皮质破坏不明显,无骨膜反应;巨细胞修复性肉芽肿2例,主要CT表现为病灶内可见多发骨性分隔,MRI上可见病灶呈多房样改变;胆固醇性肉芽肿1例,在T1WI、T2WI及压脂图像上病灶均呈高信号,有一定特征性;动脉瘤样骨囊肿1例,其特征性影像表现为病灶内可见液 液平面。结论：部分颅骨良性病变具有特征性的影像学表现,CT及MRI检查有助于这类病变的诊断及鉴别诊断。     

颅骨动脉瘤样骨囊肿的影像学表现

目的：探讨颅骨动脉瘤样骨囊肿的影像学表现，提高对颅骨动脉瘤样骨囊肿的认识。资料与方法：搜集经手术病理证实的4例颅骨动脉瘤样骨囊肿，全部病例均作了CT平扫与MRI检查，其中1例摄有颅骨平片，1例MR／增强扫描，1例DSA检查。结果：4例颅骨动脉瘤样骨囊肿中，1例位于左蝶骨嵴和左眶骨处，2例位于左颞骨。1例位于右额骨。CT上均表现为不同程度的膨胀性吹气球样溶骨破坏区，密度不均匀；MRI示有出血、囊变及液面，T1WI和R2WI上呈混杂信号，1例增强后示肿瘤实质和邻近脑膜强化；血管造影示血管有推移改变。结论：颅骨动脉瘤样骨囊肿的影像学表现有一定的特征性，CT与MRI相结合能提示诊断，并有助于评价周围结构。     

原发性及继发性动脉瘤样骨囊肿的影像学诊断

目的：分析原发性及继发性动脉瘤样骨囊肿（ABC）的影像学表现,评价其影像学诊断价值。材料和方法：回顾性分析经手术或活检证实的动脉瘤样骨囊肿176例,其中原发性动脉瘤样骨囊肿111例,继发性动脉瘤样骨囊肿65例。完整影像学资料共42例,均行X线检查,其中30例行CT检查,15例行MRI检查,9例同时行CT及MRI检查。结果：42例动脉瘤样骨囊肿平片上根据病变部位分偏心型22例、髓内型18例、骨旁型2例,大多数表现为偏心型膨胀性骨破坏;CT扫描可见25例不同程度骨膨胀、骨皮质内缘的分房状压迹和骨嵴影,皮质破坏断缺7例,15例见骨包壳,3例见液-液平面;15例MRI扫描表现为分叶状肿块,9例MRI表现为T1WI低、T2WI高信号囊腔,6例表现为混杂信号,囊间隔均为T1WI、T2WI低信号,6例行MRI增强扫描,均见间隔强化,5例见液-液平面。结论：原发性及继发性动脉瘤样骨囊肿具有一定的影像学特征,X线、CT及MRI三者结合能明显提高诊断正确率。     

颅骨骨化性纤维瘤的CT、MRI表现与组织病理学相关性分析

目的 探讨颅骨骨化性纤维瘤的CT、MRI表现与组织病理学的相关关系.方法 回顾性分析经手术病理证实的9例颅骨骨化性纤维瘤的影像学和组织病理学资料.结果 CT表现:骨窗上病变呈膨胀性密度不均的肿块6例,类圆形密度不均的多层性囊性肿块2例,骨化性致密团块1例.其中有骨壳边缘5例,瘤内可见大小不等的囊状低密度区,伴网状纤维性分隔4例、骨性分隔3例,散在钙斑3例.MRI表现:肿瘤实性部分于T1WI呈低信号2例、等信号1例,混杂信号3例,T2WI呈低信号2例、等信号1例,混杂信号3例.肿瘤内囊变、坏死,T1WI呈低信号,T2WI为高信号.CT、MRI增强检查均显示肿瘤实性部分、囊壁及纤维分隔明显强化.组织病理学显示肿瘤由成骨性纤维组织构成,在纤维组织增生中散布着成熟程度不同的小梁样骨组织.结论 CT骨窗对颅骨骨化性纤维瘤的诊断价值较大,MRI能对肿瘤内不同成分的辨别提供帮助.     

同种异体骨复合自体红骨髓移植研究进展

骨肿瘤、骨创伤等多种原因引起的骨缺损、骨不连的治疗一直是困扰骨科医生的难题之一，本文综述了应用同种异体骨复合自体红骨髓移植的发展概况、可能愈合机制、影响手术成功的诸多因素以及今后需进一步研究解决的一系列问题等，为该方法的深入研究提供一个较为系统的思路。     

Aneurysmal bone cyst of the temporal bone

Summary Aneurysmal bone cysts occurring within the calvarium are uncommon. The following case report describes the radiological and pathological findings of a temporal bone aneurysmal bone cyst with intra- and extracranial manifestations. The pertinent literature is reviewed.     

同种异体骨复合自体红骨髓移植研究进展

骨肿瘤、骨创伤等多种原因引起的骨缺损、骨不连的治疗一直是困扰骨科医生的难题之一,本文综述了应用同种异体骨复合自体红骨髓移植的发展概况、可能愈合机制、影响手术成功的诸多因素以及今后需进一步研究解决的一系列问题等,为该方法的深入研究提供一个较为系统的思路.     

可塑形组织工程骨体内成骨的实验研究

目的探讨用藻酸钙凝胶、成骨细胞、生物衍生颗粒骨复合构建可塑形组织工程骨及其修补兔颅骨缺损的体内成骨。方法24只日本大耳白兔,随机分为两组,用藻酸钙凝胶-成骨细胞-生物衍生颗粒骨和藻酸钙凝胶-生物衍生颗粒骨分别填补修复A组(16只)兔颅骨左右两侧直径1cm的圆形骨膜-全层颅骨缺损(左侧为A1组,右侧为A2组),B组(8只)为空白对照组。通过大体、组织学观察和图像分析、X线、钙磷含量测定评估其体内成骨状况。结果材料植入后,局部未见异常反应。(1)A1组手术后12周时颅骨缺损已基本被硬组织所修复,镜下见修复材料已大多被骨组织替代,颗粒骨被吸收,成骨面积百分比为(40.92±19.36)%,明显高于A2组(P<0.05)和B组(P<0.01)。X线片见兔颅骨缺损处有高密度骨痂影存在,布满整个缺损区。缺损修复组织的钙、磷含量分别为(7.30±0.93)mg、(3.11±0.42)mg,明显高于A2组和B组。(2)A2组手术后12周,颅骨缺损部分被硬性组织所修复,镜下见材料部分转变成骨组织和纤维组织,成骨面积百分比为(18.51±6.01)%,高于B组,但差异无统计学意义,X线片见兔颅骨缺损处高密度骨痂影主要分布在缺损区的边缘部位。缺损修复组织的钙、磷含量分别为(5.29±0.17)mg、(2.34±0.35)mg,明显高于B组。(3)B组骨缺损主要被膜样组织修复,在紧邻骨缺损处有硬组织形成,镜下见修复组织边缘有骨组织存在,中央大部为膜状致密纤维组织,成骨面积百分比为(12.72±9.46)%,X线片仅见靠近骨缺损边缘的部位存在致密骨痂影。缺损修复组织的钙、磷含量分别为(3.54±0.45)mg、(1.78±0.53)mg。结论藻酸钙凝胶-成骨细胞-生物衍生颗粒骨构建的可塑形组织工程骨可根据颅骨缺损的形态进行塑形填补,在体内有良好的成骨能力,可基本达到对兔颅骨缺损的骨性修复。     

骨劈开术在口腔种植骨增量中的应用

目的探讨种植区骨量不足患者行骨劈开增量,并同期植入种植体的临床效果。方法 18例种植区骨量不足,牙槽嵴高度充足但厚度仅3～5 mm的患者。行骨劈开术并同期植入ITI种植体,直径3.3～4.1 mm,共计24枚,18例均采用固定修复。结果 24枚种植体均形成良好的骨结合,负载12～24个月,无一种植体失败,功能和美学效果满意。结论上颌牙槽嵴骨宽度为3～5 mm时,采用骨劈开术能有效增加骨量并可同期植入种植体,获得满意的临床疗效。     

Intradiploic frontal bone aneurysmal bone cyst in a child: a case report

This report presents the imaging appearances of an uncommon case of intradiploic frontal bone aneurysmal bone cyst (ABC) in a 10-year-old girl. ABCs are rare in the calvarium. The radiological and aetiopathological differences between the more commonly occurring ABCs of the long bones and vertebrae, and their rarer counterparts in the calvarium and facial bones, have been discussed. Unique also to this case is the reconstruction performed using the outer table of the bone flap after excising the tumour.     

Assessment of penile bone graft viability by bone scintigraphy: A case report

A 20-year-old man, who had penile reconstruction surgery with an iliac bone graft a year ago due to malcircumcision at 6 years old underwent bone scintigraphy in order to detect bone graft viability. The accumulation of 99mTc-MDP in the penile region revealed the viability of the bone graft. This case report shows that bone scintigraphy can be used to assess the viability of a bone graft located inside the penis as well as bone grafts placed elsewhere in the extremities.     

骨微损伤与骨重建

在生理运动范围内,一定量的重复性力学载荷可以引起骨微损伤,甚至发生骨骼的断裂。然而,骨组织可以通过某种的反馈机制进行自我修复和重建,来适应不断变化的力学环境。本文综述了骨微损伤的发生、发展和影响因素,以及与骨重建的关系和相关机制。     

Malignant transformation in bone lipomas

This report presents four cases of presumed malignant transformation within intraosseous lipomas, one occurring in a stage I lesion and three in stage III lesions, according to my classification. These lesions demonstrated radiologic and histologic features of benign lipomas together with histologic fields of either malignant fibrous histiocytoma or liposarcoma. In two of the three patients who were followed up, the tumors were fatal despite amputation. Malignant transformation of a lipoma should be suspected when rapid bone destruction is seen in a stage I radiolucent lipoma. Malignant transformation of stage III lipomas could be mistaken for malignant transformation within bone infarcts.     

Diagnostic accuracy of bone metastases detection in cancer patients: Comparison between bone scintigraphy and whole-body FDG-PET

18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has become widely available and an important oncological technique. To evaluate the influence of PET on detection of bone metastasis, we compared the diagnostic accuracy of PET and conventional bone scintigraphy (BS) in a variety of cancer patients. METHODS: Consecutive ninety-five patients with various cancers, who received both PET and BS within one month, were retrospectively analyzed. A whole-body PET (from face to upper thigh) and a standard whole body BS were performed and these images were interpreted by two experienced nuclear medicine physicians with and without patient information using monitor diagnosis. Each image interpretation was performed according to 8 separate areas (skull, vertebra, upper limbs, sternum and clavicles, scapula, ribs, pelvis, and lower limbs) using a 5-point-scale (0: definitely negative, 1: probably negative, 2: equivocal, 3: probably positive, 4: definitely positive for bone metastasis). RESULTS: Twenty-one of 95 patients (22.1%) with 43 of 760 areas (5.7%) of bone metastases were finally confirmed. In untreated patients, 12 of 14 bone metastasis positive patients were detected by PET, while 9 of 14 were detected by BS. Three cases showed true positive in PET and false negative in BS due to osteolytic type bone metastases. In untreated cases, PET with and without clinical information showed better sensitivity than BS in patient-based diagnosis. For the purpose of treatment effect evaluation, PET showed better results because of its ability in the evaluation of rapid response of tumor cells to chemotherapy. Out of 10 cases of multiple-area metastases, 9 cases included vertebrae. There was only one solitary lesion located outside of FOV of PET scan in the femur, but with clinical information that was no problem for PET diagnosis. CONCLUSION: Diagnostic accuracy of bone metastasis was comparable in PET and BS in the present study. In a usual clinical condition, limited FOV (from face to upper thigh) of PET scan may not be a major drawback in the detection of bone metastases because of the relatively low risk of solitary bone metastasis in skull bone and lower limbs.