原发性甲状旁腺机能亢进性骨病影像学表现

Skeletal disease in primary hyperparathyroidism： X-ray, CT and MR imaging foundings

目的分析原发性甲状旁腺机能亢进（PHPT）性骨病的x线、CT和MR表现，探讨相关临床影像特点和鉴别诊断。方法收集1999年3月至2012年1月北京积水潭医院30例甲状旁腺机能亢进性骨病患者，均经手术及病理证实，其中股骨病变15例、胫骨干15例、腓骨干12例、髂骨14例、椎体3例、肱骨3例、肋骨5例和指骨12例。所有病例均行局部骨X线、cT和MR检查，对其影像学表现与病理结果进行对照，并由双盲法分析确认。结果30例中均表现有不同程度的全身性骨质疏松。骨吸收20（66．7％）例，其中骨膜下骨吸收12例（40．0％）、皮质内骨吸收11例（36．7％），软骨下骨吸收10例（33．3％）。纤维囊性骨炎／棕色瘤19例（63．3％）。病理性骨折5例（16．7％）。结论x线、cT和MRI从不同方面反映PHPT骨病的影像病理特点，髂骨是常见的好发部位，可侵犯骶髂关节。PHPT骨病应与溶骨性转移性骨肿瘤、骨纤维异常增殖症、骨巨细胞瘤和动脉瘤样骨囊肿相鉴别。

Objective To analyze the X-ray, CT and MR imaging findings in skeletal disease with primary hyperparathyroidism（ PHPT）, so as to discuss the clinic feature and differential diagnosis. Methods Thirty patients with PHPT were confirmed by surgery and pathological examination. In 15 patients the lesion were found in femur. There were 15 tibia, 12 fibula, and 14 iliae lesions. In three patients lesions were found in vertebrae. Three patients had lesions in humeri. In five patients lesions were found in rib. Twelve patients had lesions in phalanges. Thirty patients were studied preoperatively with radiographs, CT and MR imaging. The imaging findings were compared with the pathologic diagnosis and confirmed by double blind method. Results Radiographs of the bone in 30 patients showed generalised osteopaenia. There were 20 （66. 7% ） cases with bone resorption, which include 12（40. 0% ） cases with subperiosteal resorption, 11 （36. 7% ） cases with cortical bone resorption, and 10（33.3% ） cases with subchondral resorption. There were 19 （63.3%）cases with osteitis fibrosa cystica/brown tumor. There were 5 （16. 7% ） paitents sustained a pathological fracture. Conclusion X-ray, CT and MR imaging foundings reflect the imaging and pathology features in skeletal disease of PHPT. The iliac lesions could been found in common, and usually eroding sacroiliac joint. Skeletal disease of PHPT should be differentiated from osteolytic metastatic tumor of bone, osteodysplasia fibrosa, giant cell tumor of bone and aneurysmal bone cysts.