纤维性骨皮质缺损的X线、CT诊断价值

目的评价纤维性骨皮质缺损的X线与CT诊断价值。方法18例(21个病灶)均有平片资料,其中13例(14个病灶)有CT资料,8例(9个病灶)经随访观察1~3年,2例手术病理证实。重点分析X线、CT特点。结果18例共21个病灶,其中股骨远侧干骺部10个,胫骨近侧干骺部5个,胫骨骨干3个,股骨近侧干骺部2个,肱骨近侧干骺部1个;单发15例,多发3例。X线表现:多呈类圆形或椭圆形的低密度灶,切线位呈杯口状或碟状的骨皮质缺损区,病灶内缘可见硬化边,周围未见骨膜反应及软组织肿胀。14个病灶CT表现:缺损可位于骨皮质表层(11个)或骨皮质内(3个),位于骨皮质表层者缺损表面无骨壳,局限于骨皮质内者缺损表面骨壳可完整;7个病灶凹向髓腔并以硬化边与髓腔分隔,但无膨胀性改变或突入髓腔;灶内为均匀软组织密度,未见钙化灶。9个病灶经随访观察,其中4个病灶无改变,4个病灶稍有缩小,1个病灶发展为非骨化性纤维瘤。结论典型的纤维性骨皮质缺损单凭平片即可诊断,但CT比平片更有价值。

X-ray and CT Diagnosis of Fibrous Cortical Defect

Objective To evaluate X-ray and CT diagnostic value of fibrous cortical defect(FCD). Methods 18 cases(21 lesions) with fibrous cortical defect were examined with radiography,and CT scan was performed in 13 cases(14 lesions),8 cases(9 lesions) werefollowed up for 1~3 years.2 cases were proved by operation and pathology.The analysis was focused on the X-ray and CT features. Results Total 21 lesions were found in 18 cases,of which the lesion was located at distal metaphysis of femur in 10,at proximal metaphysis of tibia in 5,at diaphysis of tibia in 3,at proximal metaphysis of femur in 2 and at proximal metaphysis of humerus in 1.Single lesion was seen in 15 patients,while multiple lesions in 3.On radiography,the lesions mostly appeared as round or oval low dense area;on tangential projection,the lesions presented as the mouth of cup or crateriform;all lesions had a clear sclerosing margin at the marrow side and without periosteal reaction as well as soft tissue swelling around.On CT scan,11 lesions were located within cortical bone and the bone shell was notdetected on the surface of defect,while 3 lesions were located at surface of cortical bone with the bone shell on the surface of defect.7 lesions were indentation to bone marrow cavity slightly and separated with a sclerotic margin,the lesions did not protrude into marrow cavityor expand.The soft tissue within the lesion was even in soft tissue density without calcifications.During following-up period,1 lesionenlarged and developed into nonossifying fibroma,while regression of the lesion in some extent was seen in 4,and 4 lesions remained the same. Conclusion Typical FCD can be diagnosed by X-ray plain film alone,while CT scan is superior to X-ray in displaying the lesion.