骨良性纤维病变的影像与病理学分析

目的 提高对骨内良性纤维性病变的影像诊断和鉴别诊断能力. 资料与方法 对96例纤维性骨皮质缺损(FCD)、非骨化性纤维瘤(NOF)、骨化性纤维瘤(OF)和骨纤维异常增殖症(FD)患者的临床、影像学和病理学资料进行比较分析. 结果 FCD和NOF均好发于膝周骨,病理均为无成骨的纤维组织,X线和CT上表现为局限于皮质内和皮质内偏心性膨胀累及髓腔的均匀软组织密度影,MRI上主要为等T1、等T2异常信号.OF和FD病理表现交叉重叠,但OF中成骨细胞镶边现象明显多于FD.OF常见于颅面骨髓腔和胫骨前侧皮质下,表现为单骨内边界清楚的膨胀性不均匀钙质样密度.FD表现为单骨局灶性、弥漫性或多骨囊状膨胀性磨玻璃样改变,MRI上主要为等T1信号,等高混杂T2信号,局灶性FD边缘清楚伴有硬化边,弥漫性FD边界不清. 结论 FCD和NOF因具有相同的好发部位和组织学表现而可将影像学上病变局限于骨皮质者视为FCD,膨胀侵及髓腔者视为NOF.OF和FD的影像学鉴别点在于病变部位、边界和累及范围.

The Analysis of Imaging and Pathology on Benign Fibrous Lesions of Bone

Objective To improve the imaging diagnostic accuracy of benign fibrous lesions of bone.Materials and methods The clinical,imaging and pathological data of 96 cases with FCD,NOF,OF,and FD were analyzed and compared.Results FCD and NOF were often located in bone around knee joint and their pathologic findings were composed of nonossifying fibrous tissue.FCD and NOF showed intracortical lesion of uniform soft tissue density on plain X film and CT images as well as isointensity signal on MRI,which expanded into medullary cavity.OF and FD had overlapping pathological findings,however,bony trabeculae rimmed with osteoblast cells embedded in a fibrous stroma was more often seen in OF.OF often located in medullary cavity of craniofacial bone and anterior cortical bone of tibia,which had extensive growth pattern with well defined calcium-like density.FD showed focal,diffuse and multiple cystic or "ground glass" high-density in medullary cavity.The signal was mainly isointensity on T1WI and iso/hyperintensity signal on T2WI.The focal FD had clearly sclerotic margin whereas the diffuse FD had ill defined extension.Conclusions FCD and NOF have similar location and pathology results.An intracortical lesion can be regarded as FCD,whereas one extending into medullary cavity as NOF.The key of imaging differential diagnosis between OF and NOF is their location,growth pattern,margin and affected range.