颌骨骨促结缔组织增生性纤维瘤的影像学特点和鉴别诊断

目的:探讨颌骨骨促结缔组织增生性纤维瘤的影像学征象,以提高对其诊断和鉴别诊断的准确性。方法:回顾分析8例颌骨骨促结缔组织增生性纤维瘤患者的影像学资料,其中男3例,女5例;年龄2～70岁(平均28岁);2例为上颌骨,6例为下颌骨。8例中4例有局部复发,复发的平均年限为1a。无远处转移。结果:X线平片上,病灶长轴沿上、下颌骨的长轴走向,呈现偏心性或中心性生长。骨质破坏呈膨胀性、溶骨性,肿瘤骨与正常骨之间的过渡带较窄,无明显的骨质反应线(除1例复发的小病灶外)。骨皮质膨胀变薄,无骨膜反应。病灶内部可有分房或切迹。CT像上,髓腔密度增高,正常骨小梁被软组织密度肿块所取代,软组织肿块基本均匀,病变突破骨皮质,侵犯周围组织形成肿块,肿块内无钙化和骨化。MRI上,T1WI为均匀等信号,T2WI为不均匀的高信号;增强后病灶无明显强化。波谱见胆碱波。下颌骨病变发生于下颌角、后牙区、下颌支,上颌骨发生于后牙和上颌结节区。结论:了解骨促结缔组织增生性纤维瘤的影像学特点非常重要,因其较其他的纤维性病变更具有侵袭性,手术需要更大的局部切除范围和更长期密切的随访,以防局部复发。

Imaging features and differentiated diagnosis of desmoplastic fibroma of the jaw bones

PURPOSE: To investigate the imaging feature of desmoplastic fibroma (DF) of the jaw bones. METHODS: The records including diagnostic radiograph images of 8 patients were retrospectively analyzed. The age of the 8 patients ranged from 2 years to 70 years (means,28 years). The numbers of males and females were 3 and 5 respectively. Of 8 patients,4 had local recurrence, which occurred 1 year after curettage. RESULTS: On conventional radiographs, the lesion was presented as a purely lytic tumor that did not contain any mineralized matrix. The zone of transition between tumor and normal bone was typically narrow and well defined but not sclerotic. Bone expansion in DF had an eccentric(n=3)and lace-like, reticular pattern (n=3).On CT scan, increased bone marrow density (n=3), a homogeneous soft-tissue density mass displaced adjacent muscle with lingual cortex eroded(n=3) were noted. On MRI, the lesion was displayed as large bony destruction area,with homogeneous hypointensity on T1-weighted images, non-homogenous hyperintensity on T2-weighted and did not enhance after Gd-DTPA administration. Images with Choline peek(Cho,at 3.2ppm) was displayed at TE of 144 ms(PRESS,single voxel).Six mandibular cases and 2 maxillary tumors were located posteriorly . CONCLUSIONS: Recognition of DF is important because DF is more aggressive than other benign fibrous lesions, necessitating a wide surgical and careful long-term follow-up for local recurrence.