股骨颈常见骨肿瘤和肿瘤样病变的CT诊断

CT findings of tumor or tumor-like lesions in femoral neck

目的分析股骨颈常见肿瘤和肿瘤样病变的CT表现,探讨相关的临床影像特点。方法回顾性分析55例经病理证实的股骨颈肿瘤和肿瘤样病变CT表现,总结常见的股骨颈肿瘤和肿瘤样病变的影像学特征。结果骨样骨瘤11例,可见到位于关节囊内类圆形低密度瘤巢,周围骨质硬化发生在关节外;骨巨细胞瘤8例,表现为股骨颈偏心性溶骨性骨破坏,边界清楚,周围硬化不明显,中央无钙化,增强后有明显强化;转移瘤4例,表现为股骨颈不规则浸润性骨质破坏,累及骨皮质,伴或不伴周围软组织肿块形成;骨髓瘤2例,表现为单发或多发类圆形溶骨性骨质破坏,边界清楚,多发破坏区呈"穿凿样"改变。单纯性骨囊肿8例,表现为沿股骨颈长轴走行的椭圆形或地图样骨质破坏区,边缘轻度硬化,增强扫描无明显强化;动脉瘤样骨囊肿2例,表现为股骨颈囊样溶骨性骨破坏,中心型,边缘硬化,CT扫描可显示多发囊腔;骨纤维异常增殖症20例,表现为股骨颈地图样、略膨胀骨质破坏区,边界清楚,边缘硬化明显,内多呈磨玻璃样密度。结论股骨颈病变的发病年龄及病种比较广泛,大部分病变都有其典型CT表现,部分病例需与其他病变相鉴别。

Objective To analyze the imaging appearance and to explore the diagnosis value of CT in tumor or tumor-like lesions of femoral neck. Methods Fifty-five cases with femoral neck lesions proved by operation and pathology were analyzed, and radiographic features were analyzed retrospectively. Results There were 11 cases of osteoid osteoma, characterized by radiolucent nidus within the joint and bone sclerosis mainly in extra-articular areas. There were 8 cases of giant cell tumors, characterized by eccentric, expanded bony destruction without obvious sclerosis in peripheral and calcification in the center area. After intravenous injection, obvious enhancement was seen. Bone metastasis （4 cases） on the CT scan showed irregular, ill-defined lesion involving cortical destruction, with or without surrounding soft tissue. Multiple myeloma （2 cases） appeared as single or numerous, lytic, welbcircumscribed, round, punched-out lesions. Solitary bone cyst （8 cases） demonstrateed as well-defined, ovid or geographic lesions with thin sclerotic margins, and no enhancement. Aneurysmal hone cyst （2 cases） appeared as sharply defined, eentric, osteolytic lesions, with thin sclerotic margins and hone septations in the lesion, additionally. CT could demonstrate multiple cysts. There were 20 cases of fibrous dysplasia, showing a geographic, well-defined, minimal expansion lesion, with ground-glass matrix and ＂cloud of smoke＂ calcification. Conclusion There is a huge range in the onset age and disease types in femoral neck lesions. Most have typical imaging characteristics, and some lesions need to be differentiated from others.