骨内脂肪瘤的X线、CT和MRI影像学特点分析

目的：探讨骨内脂肪瘤（intraosseouslipoma，IOL）的X线、CT和MRI的影像学特点及诊断价值，提高诊断及鉴别诊断的准确性。方法回顾性分析38例经皮穿刺活检和手术病理证实的IOLX线、CT和MRI影像学特点，并与病理结果进行对照。结果38例IOL发生部位分别为：跟骨11例，股骨8例，胫骨5例，髂骨6例，肱骨6例，桡骨1例，距骨1例；所有病例均属于单囊型；X线平片和CT扫描中，11例见钙化，19例见骨嵴，4例见双重硬化带，21例病灶周围伴硬化边缘，16例见骨膨胀，所有病例CT上都能确定脂肪组织密度，CT值为-40 HU～-133 HU；MRI显示所有病例都有脂肪成分，其中9例见囊性部分，20例见信号强度不均匀的部分。Milgram分型，I期4例，II期4例，III期30例。结论 X线、CT能显示病灶部位、形态、病灶内钙化、骨嵴、病灶周边硬化、骨膨胀以及有无边界。MRI能显示病灶内脂肪成分，脂肪坏死、囊性变、黏液样变性、炎性改变、病变范围及边界。X线、CT和MRI从不同方面反映IOL的影像学特点。

An analysis of imaging characteristics of X-ray,computed tomography and magnetic resonance imaging of intraosseous lipoma

Objective To investigate the imaging characteristics of X-ray, computed tomography （ CT ） and magnetic resonance imaging （ MRI ） of intraosseous lipoma and to improve the accuracy of diagnosis and differential diagnosis.Methods The imaging characteristics of X-ray, CT and MRI in 38 cases of intraosseous lipoma conifrmed by percutaneous puncture biopsy and pathological test were analyzed retrospectively, which was compared with pathological outcomes.Results Intraosseous lipoma was noticed in the calcaneus （n=11 ）, in the femur （n=8 ）, in the tibia （n=5 ）, in the ilium （n=6 ）, in the humerus （n=6 ）, in the radius （ n=1 ） and in the talus （n=1 ） respectively. There were 38 cases of single cystic type in all. Based on the X-ray and CT, calciifcation was found in 11 cases, bone crest in 19 cases, double sclerotic band in 4 cases, sclerotic border in 21 cases and bone expansion in 16 cases. Lipo density could be determined by CT in all the cases. The CT value was -40HU - -133HU. The MRI showed there was fat component in all the cases. Among them, cyst formation was detected in 9 cases, and inhomogeneous signal in 20 cases. According to Milgram’s stage, 4 cases were at stage I, 4 cases at stage II and 30 cases at stage III. Conclusions The X-ray and CT can show the lesion site, morphology, calcification, bone crest, sclerotic border, bone expansion and with or without boundary. The MRI can make clear fat component, fat necrosis, cyst formation, myxoid change, inlfammation, range and border of the lesion. The X-ray, CT and MRI relfect imaging characteristics of intraosseous lipoma from different aspects.