The multiscan appearance of eosinophilic granuloma.

A case of multifocal eosinophilic granuloma is presented in which a 99mTc-methylene diphosphonate bone scan revealed areas of increased, normal, and decreased uptake of the radionuclide. A radiographic bone survey demonstrated some but not all of the lesions seen on the bone scan; additionally, certain lesions were demonstrated only by the radiographs. A radionuclide bone scan is therefore unreliable as the sole diagnostic procedure for evaluating the distribution of eosinophilic granuloma and should always be complemented with a radiographic bone survey.     

MR imaging of infiltrative muscle involvement with Langerhans cell histiocytosis

Langerhans cell histiocytosis (LCH) consists of three clinical syndromes of varying severity resulting from basic cellular defect leading to lipid deposition within histiocytes. Radiologically, bone lesions are similar in all three forms of LCH and are due to bone destruction. An eosinophilic granuloma of the bone can involve skeletal muscle by direct extension from the bone. However, skeletal muscle involvement is rare and is not reported on MR imaging previously in the English literature. Our case not only shows biopsy-proven muscle involvement by LCH but also reports the first diffuse nodular pattern of muscle involvement by LCH.     

Radionuclide bone scintigraphy in patients with histiocytosis X

The term histiocytosis X (HX) refers to a spectrum of disorders varying from unifocal eosinophilic granuloma (UEG), multifocal eosinophilic granuloma (MEG), to the Abt-Letterer-Siwe syndrome. In a series of 16 patients with different types of HX and skeletal lesions, whole body bone scintigraphy was performed at the time of diagnosis and during follow up. Results were compared with radiographic findings.In patients with MEG with or without extra-skeletal dissemination bone scintigraphy revealed cold spots or hot spots, but half of the lesions were not visualised scintigraphically, resulting in false negative scans. In UEG the lesions were visualised as areas of increased uptake or as a cold spot with increased uptake at its borders. No false negative scans were encountered. The reliability of skeletal scintigraphy in patients with HX seems to depend on the type of the disorder: in UEG bone scintigraphy is a safe procedure. In MEG false negative bone scans have to be expected, and radiography is superior.     

Bone and liver images in medullary carcinoma of the thyroid gland: concise communication

Thirty-four patients with surgically documented medullary carcinoma of the thyroid (MCT) and elevated serum calcitonin levels had Tc-99m phosphate bone and/or Tc-99m sulfur colloid liver images for suspected metastases. Liver images demonstrated metastatic lesions in nine of 32 patients (28%). Bone images were positive for metastases in eight of 30 patients (27%). Four of these eight abnormal bone studies detected only skeletal lesions, two demonstrated only extraosseous metastases, and two showed both kinds. Of 18 patients with both radionuclide bone studies and skeletal radiographs, four demonstrated skeletal metastases, and lesions were recognized on both examinations. This study demonstrates that radionuclide bone and liver images frequently detect metastatic lesions in patients with MCT and elevated serum calcitonin levels, and that some nonskeletal metastases in patients with this tumor display an unusual affinity for bone-seeking radiotracers.     

The natural history of disappearing bone tumours and tumour-like conditions

We describe 27 cases of bone tumours or tumour-like lesions where there was spontaneous regression. The follow-up period was 2.8-16.7 years (average, 7.0 years). Fourteen of these cases were no longer visible on plain radiographs. Histological diagnosis included exostosis, eosinophilic granuloma, fibrous dysplasia, fibrous cortical defect, non-ossifying fibroma, osteoid osteoma and bone island. Most cases began to reduce in adolescence or earlier, although sclerotic type lesions showed their regression in older patients. All lesions thought to be eosinophilic granuloma began to regress after periods of less than 3 months, while the duration of the other lesions showed wide variation (1-74 months). As resolution of the lesions took between 2 and 79 months (mean, 25.0 +/- 20.3 months) we consider that the most likely mechanism was recovery of normal skeletal growth control. In exostosis with fracture, alteration of vascular supply may contribute to growth arrest, but not to subsequent remodelling stage. In inflammatory-related lesions such as eosinophilic granuloma, cessation of inflammation may be the mechanism of growth arrest, whilst temporary inflammation may stimulate osteogenic cells engaged in remodeling. In the sclerotic type, growth arrest is a less probable mechanism. Necrosis within the tumour and/or local changes in hormonal control, plus remodelling of the sclerotic area takes longer. Knowledge of the potential for spontaneous resolution may help in management of these tumour and tumour-like lesions of bone.     

儿童长骨嗜酸性肉芽肿的影像诊断

目的 :探讨儿童长骨嗜酸性肉芽肿的影像表现及鉴别诊断。材料和方法 :回顾性分析 14例经病理证实的儿童长骨嗜酸性肉芽肿的X线平片、CT及MRI表现。结果 :14例患者共发现 16个病灶 ,其中股骨 10个 ,胫骨 4个 ,腓骨及桡骨各 1个。主要表现为边界清楚的溶骨性破坏、层状骨膜反应及软组织肿块。结论 :X线平片是儿童长骨嗜酸性肉芽肿的诊断基础 ,结合CT、MRI能够提高诊断及鉴别诊断水平     

CT与平片诊断骨嗜酸性肉芽肿的评价

目的　探讨CT与平片对骨嗜酸性肉芽肿影像诊断价值。方法　回顾性分析 39例骨嗜酸性肉芽肿患者的X线、CT表现 ,且均经病理证实。结果　单发 2 2例 ,占 5 6 .4%( 2 2 /39) ,多发 17例 ,占 43.6 %( 17/39) ,单发病灶中以颅骨最多见 ,本组 8例 ,占 36 .4%( 8/2 2 )。骨嗜酸性肉芽肿的X线平片及CT表现可因病变部位及病程不同而异。结论　CT对显示骨嗜酸性肉芽肿的结构 ,尤其对于钮扣样死骨和软组织肿块的发现 ,优于X线平片 ,但不能取代X线平片检查 ,平片仍是诊断本病首选和基本方法。     

骨嗜酸性肉芽肿的影像学表现

目的:探讨骨嗜酸性肉芽肿的影像学表现,以提高对本病的认识。方法:回顾性分析15例经病理证实的骨嗜酸性肉芽肿的影像学特征。结果:15例中,单发者14例,多发者1例。单发者其中颅骨3例,髋臼2例,脊柱3例,肋骨1例,四肢长骨5例。主要影像学表现为骨质破坏、骨皮质改变、骨膜增生和软组织肿胀或肿块。术前诊断正确11例,误诊为尤文氏瘤2例、骨髓炎和骨结核各1例。结论:骨嗜酸性肉芽肿的影像学表现有一定的特征,综合分析可提高对本病的诊断水平,有助于临床诊断。     

Diffuse lymphangiomatosis of bone

Two cases of lymphangiomatosis of bone, a very rare systemic condition characterized by both skeletal and parenchymal lesions, are presented. The skeletal changes have an appearance similar to haemangiomas in the spine, and soap-bubbly lesions in the flat bones. One case carried the diagnosis of eosinophilic granuloma for 18 years. The findings on MRI, which have not been previously well-established, are discussed.     

骨嗜酸性肉芽肿影像误诊分析（附5例报告）

目的：探讨骨嗜酸性肉芽肿的影像误诊原因。方法：收集经手术病理证实的5例X线、CT及1例MRI片,由三名医生共同分析影像表现及临床资料。结果：5例分别误诊良性肿瘤、骨髓炎、结核、转移瘤及动脉瘤样骨囊肿。特点：5例均为儿童及青年、病灶均为该病的好发部位。影像表现主要为髓腔或骨松质溶骨性破坏,边缘稍有硬化。结论：在熟悉该病的X线表现基础上,与CT或MRI相互补充、印证,结合临床表现全面分析,有可能减少误诊。     

骨嗜酸性肉芽肿的影像学表现与病理对照分析

目的研究骨嗜酸性肉芽肿(EGB)影像学表现与生物学行为相关性,提高对EGB的认识。方法回顾分析31例EGB的影像表现及病理特征。结果影像表现:早期病灶5例(16.1%),中期病灶23例(74.2%),晚期病灶3例(9.7%),病理所见:早期病灶3例(9.7%),中期病灶26例(83.9%),晚期病灶2例(6.4%)。结论EGB影像学表现与病理过程有较一致的相对应关系,只是早期病理改变略早于X线表现,EGB影像学分期有利于指导临床治疗。     

Two cases of pediatric bone disease (eosinophilic granuloma and Brodie's abscess) showing similar scintigraphic and radiographic findings

Two 9-year-old patients with femoral bone lesions were referred to the authors' institution within a few days of each other. Both showed similar radiographic, magnetic resonance imaging, and scintigraphic findings. The radiographs showed osteolytic lesions in the right femoral diaphyses, and gadolinium-DTPA-enhanced magnetic resonance imaging revealed inhomogeneous enhancement. Tc-99m HMDP showed marked linear accumulation with relatively low central uptake in the right femoral shafts, and TI-201 scintigraphy showed considerable uptake corresponding to the area seen with Tc-99m HMDP. Histologic analysis confirmed eosinophilic granuloma in the first patient and Brodie's abscess in the second. The radiographic and scintigraphic findings in Brodie's abscess may be similar to those in eosinophilic granuloma.     

Benign bone tumors and tumor-like lesions: value of cross-sectional imaging

This article reviews the role of CT and MR imaging in the diagnosis of benign bone tumors and tumor-like lesions of bone with with regard to differential diagnosis, the assessment of tumor-related complications, and the detection of postoperative recurrence. Indications for cross-sectional imaging of specific lesions, including osteoid osteoma, osteoblastoma, enchondroma, osteochondroma, intraosseous lipoma, hemangioma, giant cell tumor, aneurysmal bone cyst, simple bone cyst, and eosinophilic granuloma, are discussed, and advantages and disadvantages of the different imaging modalities are illustrated on the basis of pathologically confirmed cases.     

骨嗜酸性肉芽肿的放射学诊断（附60例分析）

作者回顾性分析６０例骨嗜酸性肉芽肿的影像学表现，着重探讨其影像学的特点，并认为ＣＴ对显示骨嗜酸性肉芽肿的结构，尤其对于钮扣样死骨和软组织肿块的发现，优于Ｘ线平片。     

Misleading aggressive MR imaging appearance of some benign musculoskeletal lesions.

After plain radiography has been performed, magnetic resonance (MR) imaging is considered the modality of choice for the evaluation of suspected musculoskeletal lesions because of its exquisite sensitivity to changes in the signal intensity of marrow and soft tissue. That sensitivity, however, may lead to an overestimation of the aggressiveness and extent of some benign bone lesions, particularly in children. Such lesions include chondroblastoma, osteoid osteoma, eosinophilic granuloma, and stress fractures. Potentially misleading MR features commonly seen include prominent marrow edema, soft-tissue edema, and apparent mass effect adjacent to the bone lesion. Features that these lesions have in common that may explain the MR findings include associated inflammatory reactions caused by the lesions and their occurrence in childhood, when the periosteum is more loosely attached. Knowledge of the potential pitfalls encountered with MR imaging may help explain the discrepancy between the radiographic and MR appearances of these benign lesions and avoid misplaced reliance on MR imaging for a diagnosis. Radiography remains the single most valuable modality in determining a differential diagnosis for bone lesions.     

多发性骨嗜酸性肉芽肿的影像学表现(附11例分析)

目的:探讨多发性骨嗜酸性肉芽肿的影像学表现特征.方法:回顾分析经手术病理证实的11例多发性骨嗜酸性肉芽肿的X线、CT和MRI资料.结果:全部病例共计41处病灶,其中脊椎13处、颅骨11处、骨盆6处、锁骨4处、肋骨4处、四肢长骨3处.病灶最多之病例累及12骨,共16处病灶.本病基本影像学表现相似,但不同部位及不同病程影像学表现具有一定特征性.结论:X线平片是不可缺少的首选检查.CT在显示复杂骨骼解剖、病灶细微结构方面优于X线平片,有利于早期发现病变及帮助定性与鉴别诊断.MRI对于准确显示病变范围及邻近组织改变有明显优势.     

颅骨嗜酸性肉芽肿的CT和MRI诊断

目的探讨颅骨嗜酸性肉芽肿的CT和MRI表现，提高对其诊断和鉴别诊断水平。资料与方法回顾性分析21例经手术病理证实的颅骨嗜酸性肉芽肿的CT和MRI表现，17例行CT平扫，12例行MR检查，10例行MR增强扫描。结果21例共发现24个病灶，其中单发19例（眼眶2例，斜坡2例，额骨9例，颞骨1例，顶骨4例，枕骨1例），多发2例。CT像上主要表现为颅骨板障的破坏，边界清楚，部分病灶内可见残留的小骨片以及大小不等的软组织肿块，密度不均匀。MR表现为T1低信号，T2高信号，CT和MRI增强扫描明显强化。结论颅骨嗜酸性肉芽肿的CT和MRI表现有一定的特征，CT和MRI有助于明确颅骨嗜酸性肉芽肿的诊断。     

肋骨嗜酸性肉芽肿的X线及CT表现

目的 分析肋骨嗜酸性肉芽肿的X线及CT表现,提高对该病的诊断水平.方法 回顾性分析8例肋骨嗜酸性肉芽肿的临床资料,所有患者均经穿刺活榆或手术切除后病理证实.全部患者均行X线平片检查;6例行螺旋CT平扫,其中1例行CT增强扫描.结果 8例肋骨嗜酸性肉芽肿均为单发;6例发生于前肋,2例发生于后肋;X线均表现为单房类圆形骨质破坏,境界较清楚.CT扫描表现:5例呈膨胀性骨质破坏,骨皮质变薄,3例呈溶骨件骨质破坏,病灶周围形成软组织肿块;1例行CT增强扫描,病灶呈中度较均匀强化.结论 肋骨嗜酸性肉芽肿的X线平片和CT表现有一定的特征性.     

肋骨嗜酸性肉芽肿的X线及CT表现

目的 分析肋骨嗜酸性肉芽肿的X线及CT表现,提高对该病的诊断水平.方法 回顾性分析8例肋骨嗜酸性肉芽肿的临床资料,所有患者均经穿刺活榆或手术切除后病理证实.全部患者均行X线平片检查;6例行螺旋CT平扫,其中1例行CT增强扫描.结果 8例肋骨嗜酸性肉芽肿均为单发;6例发生于前肋,2例发生于后肋;X线均表现为单房类圆形骨质破坏,境界较清楚.CT扫描表现:5例呈膨胀性骨质破坏,骨皮质变薄,3例呈溶骨件骨质破坏,病灶周围形成软组织肿块;1例行CT增强扫描,病灶呈中度较均匀强化.结论 肋骨嗜酸性肉芽肿的X线平片和CT表现有一定的特征性.     

骨嗜酸性肉芽肿的CT诊断及病理基础

目的:探讨骨嗜酸性肉芽肿的CT表现及其病理学基础,以提高对本病的认识。方法:回顾性分析经病理证实的12例骨嗜酸性肉芽肿的CT表现和病理资料。结果:颅骨6例,长骨1例,脊柱2例,骨盆1例,锁骨1例,肩胛骨1例。单发者11例,多发者1例。主要CT表现为溶骨性骨质破坏,边缘清晰,无反应性骨硬化。部分病例可见骨膜增生、软组织肿胀或肿块。病变在病理学上表现为局限性肉芽肿形成,朗格汉斯组织细胞和多种炎症细胞浸润。嗜酸性肉芽肿CT表现与病理学分期有相一致的对应关系,且病变同时具有肿瘤和炎症的特征。结论:骨嗜酸性肉芽肿的CT表现具有特殊的病理基础,有一定的特征性,对临床诊断有帮助。