Nora病的影像与病理对照分析

Comparative Analysis of Images and Pathology of Nora's Lesion

目的探讨Nora病的影像、病理学特征及鉴别诊断,以期提高对本病的认识及诊断水平。方法回顾性分析经手术及病理证实的5例Nora病的影像学表现并复习相关文献。由影像科医师及病理科医师共同阅片,将影像学与病理学结果进行对照分析。结果 5例Nora病均因发现局限性包块就诊,X线及CT均表现为骨旁斑片状欠均匀高密度影,边界清楚,病变与附着骨间骨髓腔不相连续,3例病变基底部存在低密度间隙。1例病变表面于MRI上见"软骨帽"样长T2信号。镜下表现为5例病变由分化成熟的软骨、骨和纤维组织3种成分无序排列,软骨形成帽状结构及掺杂在其他两种成分中,部分软骨细胞表现轻度异型性,骨基质蓝染表现为特征性的"蓝骨"。结论有助于Nora病的影像诊断指标为:(1)骨旁不规则结节灶;(2)病变直径多<30 mm;(3)X线及CT上病灶表现为欠均匀高密度结节;(4)X线及CT上病灶与附着骨间低密度间隙;(5)MRI上病变表面"软骨帽"样长T2信号。最终确诊仍需病理组织学检查。

Objective Discuss the image,pathological features and differential diagnosis of Nora＇s lesion to improve the understanding and diagnosis level of this disease. Methods Retrospectively analyzed imaging manifestations of five patients with Nora＇s lesion verified by surgery and pathology and reviewed relevant literature. The physicians in the Imaging Department and Pathology Department read the photos together to make comparative analysis of the imaging and pathological results. Results The five patients with Nora＇s lesion came for treatment because of regional masses discovered. It was indicated from X-ray and CT that they were patches of uneven and high-density images adjacent to the bones. The boundary was clear. The lesion was not continuous with the marrow cavity between adherent bones. The basilar parts of three lesions had low-density gaps. Long T2 signal like cartilage cap could be seen on one lesion＇s surface in MR. It was indicated under the microscope that the five lesions had a disorderly arrangement of differentiated and matured cartilage,bones and fibrous tissue. The cartilage formed a cap-like structure and intermixed with the other two components. Part of the cartilage cells manifested a slight atypia. The blue bone matrix showed distinctive＂blue bone＂. Conclusion The indices that are helpful to diagnose images with Nora＇s lesion are：（ 1） irregular node focus adjacent to the bones;（ 2） most lesions＇ diameters are smaller than 30mm;（ 3） the focus showed an uneven high density node on X-ray and CT;（ 4） there were low density gaps between the focus and adherent bones on X-ray and CT;（ 5） long T2signal-like cartilage cap on lesion surface on MR. The final confirmed diagnosis still requires pathological histology evidence.