骨样骨瘤的CT表现及诊断价值探讨

目的探讨CT扫描在骨样骨瘤中的诊断价值。方法对经CT诊断、临床证实的25例骨样骨瘤临床资料进行系统性分析，并与X线检查方法作比较。结果骨样骨瘤的CT表现为瘤巢及其周围形成的程度不同的反应性骨硬化。结论与X线平片相比，CT扫描易于发现骨样骨瘤的瘤巢，从而确诊本病。CT扫描在骨样骨瘤诊断中具有重要的价值。     

骨样骨瘤的影像诊断

目的探讨骨样骨瘤的X线、CT与MR表现。方法搜集我院2006—2007年经手术病理证实的骨样骨瘤20例,其中男性12例,女性8例,年龄11~37岁,平均年龄24岁。所有病例均行X线检查,其中行CT检查者6例,行MR检查者8例。分析上述3种影像检查对骨样骨瘤瘤巢的显示率。结果在常规X线检查中20例病灶均表现为一圆形或卵圆形的透亮区,直径>5~16 mm,周围可见不同程度的骨质硬化;其中16例可以看到瘤巢,显示率为80%;6例经CT薄层扫描均可清楚显示瘤巢,显示率为100%;8例行MR检查,其中6例可显示瘤巢,并可见瘤巢周围的软组织肿胀,瘤巢显示率为75%。结论瘤巢是确诊骨样骨瘤的关键。常规X线是诊断骨样骨瘤的首先检查方法,CT是显示瘤巢最可靠的方法,MR显示瘤巢不如CT敏感,但却可以清楚的显示瘤巢周围的软组织肿胀情况。     

骨样骨瘤的影像学诊断

目的分析骨样骨瘤的X线、CT及MRI表现,探讨其影像学特征。方法搜集经临床及病理证实的骨样骨瘤23例,男19例,女4例。所有病例均行X线检查,其中同时行CT检查者19例,行MR检查者7例,3种检查都进行者6例。分析骨样骨瘤的X线、CT和MRI表现,及其对瘤巢和瘤巢周围改变的显示能力,总结其特征性的影像学表现。结果23例病灶均显示一直径0.2～2.1cm大小不等的圆形或椭圆形瘤巢,边界清楚,边缘骨质不同程度硬化,骨膜反应,骨髓腔及软组织水肿或关节腔积液。24例X线平片17例显示瘤巢,19例行CT检查者均清晰显示瘤巢,7例行MR检查者5例可显示瘤巢,2例需结合X线及CT检查方能肯定诊断。X线、CT及MR对瘤巢的显示率分别为73.9%(17/23)、100%(19/19)及71.4%(5/7)。结论瘤巢是骨样骨瘤的特征性表现,CT检查是诊断骨样骨瘤最准确的方法,X线检查是诊断骨样骨瘤的重要方法,MR检查对显示瘤巢周围骨髓、软组织及关节腔情况非常敏感,仅凭X线或MR的表现易造成误诊、漏诊。     

骨样骨瘤的影像学诊断

目的 分析骨样骨瘤的X线、CT和MRI表现。方法 搜集经手术病理证实的骨样骨瘤48例，其中男33例，女15例。所有病例均行X线检查，其中同时行CT检查者32例，行MR检查者10例，3种检查方法都进行者8例。分析骨样骨瘤在X线、CT和MRI上的表现及其对瘤巢和瘤巢周围改变的显示能力。结果 48例病灶均表现为一圆形或卵圆形的透亮区，直径为0．4～1．7cm，平均9．7cm，其周围有不同程度的骨质硬化。10例行MR检查者均可见瘤巢周围的软组织、骨髓水肿或关节腔积液。48例X线平片仅37例显示瘤巢，32例行CT检查者均清楚显示瘤巢，X线和CT对瘤巢显示率分别为77％(37／48)和100％(32／32)。10例MR检查者均可作出正确诊断，其中8例能直接判断出瘤巢，另2例需对照平片或CT才能肯定。结论 瘤巢是确诊骨样骨瘤的关键，X线平片仍然是诊断骨样骨瘤的重要检查方法，CT是显示瘤巢的最佳方法，MRI能敏感地显示瘤巢周围骨髓内及软组织的炎性水肿，但可能造成误诊，结合平片或CT可作出准确诊断。     

骨样骨瘤的CT诊断价值

目的:分析骨样骨瘤的CT表现特点及其诊断价值.材料和方法:回顾性分析37例病理证实的骨样骨瘤的CT表现特点,并与平片比较瘤巢的显示能力.结果:37例中,股骨19例、胫骨10例和其它部位8例.瘤巢均表现为一圆形或卵圆形的透亮区,直径为4～15mm,平均9.4mm,周围有不同程度的骨质硬化,31例中心有钙化,形成"牛眼征".37例CT扫描瘤巢诊断率为100%,X线平片瘤巢诊断率仅为62.2%.结论:骨样骨瘤的瘤巢CT表现典型,CT是诊断骨样骨瘤最有价值的检查方法.     

骨样骨瘤的影像学表现及诊断价值分析

目的:分析骨样骨瘤的X线、CT、MRI及SPECT-CT融合图像的表现,总结其影像学特征。方法:对我院经手术或穿刺病理证实的28例骨样骨瘤的影像学表现进行回顾性分析。25例行X线检查,20例行CT检查,7例行MRI检查,9例行SPECT-CT图像融合。结果:28例均出现大小不一的圆形或椭圆形瘤巢,直径为2.3~19.5mm,瘤巢周围伴有不同程度的骨质硬化。X线对瘤巢显示率为48%(12/25),4例瘤巢中心出现钙化;CT对瘤巢显示率为95%(19/20),出现钙化者16例,2例显示"血管沟征";SPECT-CT融合图像,9例瘤巢均有显像剂团状异常浓聚,呈"太阳征";MRI对瘤巢显示率为57%(4/7),7例均显示不同程度骨髓水肿。结论:瘤巢是确诊骨样骨瘤的关键,CT是发现瘤巢的较好方法,SPECT有利于发现隐匿性病变,SPECT-CT融合图像可以明确病变及其累及的范围。     

骨样骨瘤的X线、CT和MRI表现和诊断价值

目的分析骨样骨瘤的X线、CT和MRI表现,评价它们的诊断价值。方法经手术病理证实,同时有X线、CT和MRI检查的骨样骨瘤22例,其中男19例,女3例。分析X线、CT和MRI对瘤巢和瘤巢周围改变的显示能力。结果X线、CT和MRI分别有17、22和20例表现为有一圆形或卵圆形小于2cm的瘤巢,瘤巢周围可有程度不一的骨质硬化、骨膜反应、软组织及骨髓腔水肿或相邻关节的肿胀。X线诊断的准确率为77.3%（17/22）;CT诊断的准确率为100%（22/22）;MR诊断的准确率为90.9%（20/22）。结论大多数的骨样骨瘤具有较典型的影像学表现,易于诊断,其中以CT对瘤巢的定位最为准确,单凭X线或MR的表现可因未能显示瘤巢而误、漏诊。     

骨样骨瘤的影像诊断

目的评价平片、CT,MRI对骨样骨瘤的诊断价值.方法18例骨样骨瘤均摄平片,其中16例经CT检查,4例行MRI检查;分析骨样骨瘤的平片、CT,MBI影像学表现.结果骨样骨瘤典型表现为瘤巢及周围反应性骨质硬化,且随病变部位不同而有所差异.诊断准确性平片为92.9%,CT为100%,MRI为83.3%.结论平片是诊断骨样骨瘤的基本手段,CT为最可靠方法,MRI需结合平片、CT进行诊断.     

股骨颈关节囊内骨样骨瘤的临床及影像特点

目的 分析股骨颈骨样骨瘤的临床及影像特点,提高对本病的诊断水平.方法 回顾性分析21例经手术病理证实的股骨颈骨样骨瘤的临床及影像学资料.其中男18例、女3例;年龄7～26岁,中位年龄13岁.所有病例均行常规X线及CT检查,其中同时行CT增强检查10例,行MR检查4例.结果 19例表现为髋关节疼痛,其中夜间痛11例,8例服用水杨酸类药物可缓解;另外2例仅表现为跛行.病程2个月至4年6个月,中位时间12个月.X线平片:21例中仅有10例显示瘤巢,18例股骨颈内下方呈不同程度的骨质硬化.CT:21例均清楚显示瘤巢,其中骨皮质型8例,骨膜下型6例,骨内膜型7例;20例骨质硬化均位于瘤巢下方,即髋关节囊外的股骨前内侧骨皮质;“血管沟征”19例.MRI:4例均可显示瘤巢;骨质硬化在各序列上均呈低信号;关节积液3例,骨髓水肿4例,滑膜增厚2例.结论 股骨颈骨样骨瘤的临床表现不典型,但其影像表现具有一定的特征性,瘤巢位于关节内,而骨质硬化主要发生于关节外的股骨前内侧骨皮质.CT扫捕仍然是显示瘤巢的最佳方法.     

Soft tissue edema in osteoid osteoma

Four cases of osteoid osteomas are presented. An uncharacteristic magnetic resonance finding of soft tissue edema is reported. This observation should not be misinterpreted as indicating a more aggressive pathologic process and, thereby, exclude osteoid osteoma from the differential.     

Osteoid osteoma in atypical locations: the added value of dynamic gadolinium-enhanced MR imaging

Purpose

To compare the results of dynamic gadolinium-enhanced magnetic resonance imaging (MRI), unenhanced MRI and computed tomography (CT), in terms of nidus conspicuity and diagnostic confidence of osteoid osteoma in atypical sites.

Materials and methods

CT and MR (nonenhanced T1- and T2-weighted and dynamic MRI) images of 19 patients with histologically proven osteoid osteoma located in atypical sites were retrospectively reviewed. Time-enhancement curves of the nidus and the adjacent bone marrow were generated. Images from each technique were scored for nidus conspicuity by two independent radiologists. Another blinded radiologist was asked to assess final diagnosis of the bone lesion on MR and CT images, independently.

Results

In all cases, nidus contrast uptake started in the arterial phase and was higher compared to the surrounding bone marrow. Dynamic MRI significantly increased nidus conspicuity compared to nonenhanced MRI (P < .0001) and CT (P = .04). In 6/19 (31.6%) cases nidus conspicuity was higher at dynamic MRI compared to CT. Confident diagnosis of osteoid osteoma was achieved in all patients with MRI and in 10/19 (52.6%) patients with CT.

Conclusion

In patients with osteoid osteoma located in atypical sites, dynamic MRI increases nidus conspicuity, allowing confident diagnosis.     

Peritumoral edema in osteoid osteoma on magnetic resonance imaging

Objective.To determine whether there is a relationship between the peritumoral edema caused by osteoid osteoma seen on magnetic resonance (MR) imaging and the patient’s age, duration of symptoms, or location of the lesion. Design and patients. All histologically proven osteoid osteomas seen in our institutions during a 5-year period in patients with known age, gender, duration of symptoms, and available radiological and MR imaging examinations were included in this study. The extent of the edema in the bone marrow and extraosseous soft tissue around the nidus of osteoid osteoma on T2-weighted MR imaging were graded from 1 (nonexistent) to 4 (extensive) by two masked observers. The relationships between the patient’s age, duration of symptoms, and location of lesions were evaluated by Pearson’s correlation coefficient and analysis of variance. Results.Twenty-seven cases met the inclusion criteria. The observer agreement on grading was good. Patients of 15 years of age or younger had significantly higher grades than patients older than 15 years. There was a moderate negative linear correlation between the patient’s age and peritumoral edema. No significant relationship was identified between edema and the duration of symptoms or the location of lesions. Conclusion. Osteoid osteomas in younger patients tend to be associated with more extensive peritumoral edema. Received: 13 March 1998 Revision requested: 3 August 1998 Revision received: 12 January 1999 Accepted: 2 March 1999     

Intraoperative,probe-guided curettage of osteoid osteoma

The only curative approach for osteoid osteoma is operative removal of the nidus, but intraoperative detection of the nidus is difficult even when an X-ray amplifier is used. A simple probe-guided operative procedure using technetium-99m methylene diphosphonate is described, and the results and follow-up in 12 patients are reported. In addition physical properties of the probe have been evaluated by phantom measurements. Correspondence to: B. Kirchner     

Osteoid osteoma and osteoblastoma: MRI appearances and the significance of ring enhancement

We assessed the value of contrast-enhanced fat-suppressed MRI on nine patients with osteoid osteomas and osteoblastomas. The results were compared with plain films, bone scintigraphy, computed tomography (CT) and pathological specimens. On contrast-enhanced fat-suppressed T1-weighted images the non-calcified nidi showed homogeneous enhancement, whereas the calcified lesions showed a ring enhancement sign that was proportional in intensity to the extent of the remaining part of the vascularized nidus. The degree of bone marrow and soft tissue enhancement was relative to the size and reactive inflammatory changes of the lesions. Although CT was diagnostic in most of the cases and more specific to show the calcified lesions, MRI was confirmatory in one case. We concluded that, although CT is the primary diagnostic investigation in osteoid osteomas, MRI can be reserved for equivocal cases.Correspondence to: B. A. Youssef     

Magnetic resonance imaging findings of osteoid osteoma of the proximal femur

Osteoid osteoma (OO) is a benign bone tumor whose main radiological finding is nidus. OO of the proximal femur can also result in non-specific findings such as hip joint effusion, perinidal bone marrow edema and soft tissue mass. Since the nidus may be difficult to identify with MR, these non-specific findings can lead to erroneous diagnosis. Therefore, MR imaging technique should be optimized in order to identify nidus. Since MR imaging has assumed increasing importance in the evaluation of disorders of the hip, radiologists must be aware of the spectrum of findings of OO of the proximal femur. The aim of this pictorial review is to show the MR imaging findings of intra-articular and extra-articular OO of the proximal femur.     

Recurring osteoblastoma initially presenting as a typical osteoid osteoma

Two patients each underwent inadequate excision of an osteoid osteoma and some months later developed a large tumor in the same location showing the radiographical and histological features of osteoblastoma. This rare occurrence again suggests that osteoid osteoma and osteoblastoma are closely connected benign neoplasms. Indeed some authors in the past have suggested classification as a single tumor showing different clinical and radiographical patterns.Supported by: Grant n 88.01124.44, Italian National Council of Researches, Special Project Oncology. A.I.R.C. (Italian Association for Cancer Research). Regione Emilia-Romagna, law n 1970 of May 13th, 1986. Istituto Ortopedico Rizzoli Research Funds. Interdepartmental Center for Cancer Research G. Prodi of the University of Bologna     

Osteoid osteoma of the petrous bone

We present a case of osteoid osteoma of the petrous bone presenting with progressive sensorineural hearing loss. CT showed a dense homogeneous mass at the promontory surrounded by a thin bony border. On MRI this lesion gave intermediate signal intensity on T1- and T2-weighted spin-echo images and enhanced intensely with gadolinium. Surgical removal and pathological study proved the diagnosis. Received: 13 February 1997 Accepted: 21 February 1997     

Familial occurrence of osteoid osteoma

Familial occurrence of osteoid osteoma is an exceedingly rare event. This paper describes the second report of this event, where two siblings presented with this lesion in the same location, the proximal left femur. They both presented at 6 years of age, but 3 years apart.