肩胛骨嗜酸性肉芽肿的影像学表现

Imaging Features of Scapular Eosinophilic Granuloma

目的分析肩胛骨嗜酸性肉芽肿的影像学表现,探讨其临床特点和鉴别诊断价值。方法分析8例肩胛骨嗜酸性肉芽肿的临床和X线、CT及MRI影像学资料。结果 8例患者中,所有病灶均累及关节盂部。X线平片上所有病灶表现为溶骨性骨质破坏,局部骨皮质变薄。7例行CT检查者中,4例病灶骨质破坏区可见残存细小骨碎片。6例病灶可见周围骨皮质不规则破坏中断,其中3例可见软组织肿块形成,1例见骨膜反应;1例骨皮质规则完整。1例全肩胛骨弥漫性病灶呈囊状膨胀性骨质破坏,周围见多发结节及团块状软组织肿块,同侧腋窝见多发肿大淋巴结。2例行MRI检查者病灶表现为等T_1、长T_2信号,其中1例骨皮质中断破坏,周围软组织见大片稍长T_1、长T_2信号水肿灶,T_2WI及脂肪抑制序列可见病变边缘环绕线状低信号影。结论儿童及青少年肩胛骨尤其关节盂出现溶骨性骨质破坏,相邻骨皮质变薄或破坏中断,可伴有软组织肿块,影像学改变明显而临床症状轻微,应考虑到嗜酸性肉芽肿的可能性。

Objective To evaluate the imaging features of eosinophilic granuloma of scapula, and explore the clinical features and differential diagnosis. Methods The clinical, X-ray, CT and MRI findings of 8 cases of eosinophilic granu- loma in scapula were analysed. Results The lesion involved glenoid cavity in all 8 patients. All lesions showed osteolytie bone destruetion with thinning of local bone cortex on X-ray. Seven patients underwent CT examination, of which 4 cases presented residual tiny bone fragments at bone destruction area. Six lesions showed irregular destruction and interruption of bone cortex, of which 3 cases demonstrated soft tissue mass formation, 1 case periosteal reaction. The bone cortex was reg- ular and intact in 1 case. One case of diffuse lesions in the entire scapula showed cystic and expansive bone destruction with multiple nodular and cloddy soft tissue masses. Multiple enlarged lymph nodes were found in ipsilateral axillary fossa. Two patients performed MR examination, and the lesions showed equal TI and long T2 signal intensity. One case presented interruption and destruction of the bone cortex with wide range of slightly long T~ long T2 soft tissue edema. The lesion was surrounded by linear low signal intensity on T2WI and fat suppression sequence. Conclusion In children and adoles- cents, the scapula especially glenoid cavity shows osteolytic bone destruction with thinning, destruction or interruption of adjacent bone cortex, which may accompany with soft tissue mass. The possibility of eosinophilic granuloma should be taken into consideration if the imaging changes are obvious, and the clinical symptoms are mild.