慢性骨髓炎的MRI表现及诊断价值

MRI Features and Diagnostic Utility of Chronic Osteomyelitis

目的分析慢性骨髓炎的MRI表现,探讨MRI的诊断价值。方法对经手术病理证实的11例慢性骨髓炎进行回顾性分析,均行患侧骨X线平片及MR检查,其中6例同时行MR增强扫描检查。结果 11例慢性骨髓炎中,6例位于股骨,2例位于肱骨,2例位于胫骨,1例位于锁骨;MRI显示病变多位于骨干近干骺端,范围广泛,边缘模糊,骨干增粗、部分变形,骨皮质多不规则增厚,边缘毛糙;8例骨髓腔内可见脓肿形成,T1WI呈低或等信号,T2WI呈高信号,壁厚,边缘稍模糊,增强扫描明显环形强化,脓肿周围骨松质内可见片状长T1长T2信号,边界模糊;1例局部可见软组织团块影,T1WI呈低信号,T2WI呈高低混杂信号,增强扫描明显不均匀强化;2例见肉芽肿形成,T1WI呈等信号,T2WI呈高信号,其中1例中央可见不规则长T1稍长T2信号坏死区,增强扫描实性部分明显强化,坏死区不强化;3例病例可见死骨形成,4例见骨膜水肿,2例见骨膜增厚,5例见骨膜新生骨形成,3例见窦道形成,1例见骨包壳形成;周围肌肉间隙模糊,内均可见条索状或片状长T1长T2信号。本组中,10例患者MRI诊断明确,1例同时不除外骨纤维结构不良。结论 MRI显示慢性骨髓炎的脓肿、骨膜反应、周围软组织改变及窦道优于X线,对指导临床治疗及进行疗效评价有较大的应用价值。

Objective To analyse the MRI features of chronic osteomyelitis and evaluate the diagnostic utility of MRI for diagnosing it. Methods The X-ray and MR plain images of 11 cases with chronic osteomyelitis confirmed by surgery and pathology were analyzed retrospectively.At the same time,6 cases received post-contrast MR exams. Result Among all the I 1 cases,6 lesions located at thighbones,2 humeri,2 tibias, l clavical. MRI images show that most of cases were located at blackbone nearby metaphysic with wide range and blurred boundary. The blackbone thicken and some of them were out of shape,.Bone cortex was thickening irregularly with coarse boundary. Eight cases showed abscess formation in the marrow cavity, appearing hypo-intense or iso-intense singals on Tl-weighted image and hyper-intense singals on T2-weighted image, with thick wails and slightly bhnred boundary, after adiministration of contrast medium, the tumors demonstrated hyperdense with marked annular enhancement. The adjacent spongy bone presented slice-shape T I low signal and T2 high signal and had blurred boundary. Among all the cases, 2 cases showed soft tissue mass which presented hypo-intense singals on T l-weighted image, mixed singals on T2-weighted image and hyperdense with marked inhomogeneous enhance- ment after adiministration of contrast medium. 2 cases showed the formation of granuloma which presented hypo-intense singals on Tl-weighted image and hyper-intense singals on T2-weighted image; One of them presented slice-shape T I low signal and T2 slightly high signal in the center of the lesion; After adiministration of contrast medium, the solid part demonstrated hyperdense with marked enhancement and the cystic part had not enhanced. 3 cases presented sequestration, 4 periosteal edema, 2 periosteal thickening,5 periosteal new bone, 3 sinus tracts and 1 bone bladdings. Slice-shaped TI low signal and T2 high signal can be seen in peripheral parenchyma. Among all the cases, 10 lesions had been diagnosed correctedly by MRI, 1 misdiagnosed as osteofibrous dysplasia. Conclusion MRI is better than X-ray in aspects of appearing abscess, periosteal reaction, adjacent soft tissue changes and sinus tracts, and has a great practical value in guiding clinical treatment and evaluating therapeutic.