儿童单灶性骨嗜酸性肉芽肿影像学特征分析

Solitary eosinophilic granuloma of bone: imaging features in pediatrics

目的 探讨儿童单灶性骨嗜酸性肉芽肿的影像学特征。方法 回顾性分析2008年1月-2015年12月间25例经组织病理学诊断的儿童单灶性骨嗜酸性肉芽肿的影像学资料。结果 男19例,女6例。年龄2-14岁,平均年龄6岁。长骨14例,脊柱6例,颅骨3例,锁骨1例,髂骨1例。长骨病变主要表现为骨质破坏、邻近骨皮质“扇贝样”压迹、骨膜反应和软组织肿胀或肿块。部分病变可见骨皮质钻孔样破坏、破坏区内死骨及周围硬化缘。椎体病变主要表现为椎体破坏、塌陷,呈“扁平椎”改变,部分可见椎旁软组织肿块,但椎间隙保持正常。颅骨病变主要表现为穿凿样骨质破坏,边界清晰,可见“斜坡征”。髂骨及锁骨病变缺乏特异性。病变在MRI多呈T1WI等或稍低信号,T2WI不均匀高信号。结论长骨的骨皮质“钻孔样”破坏、颅骨的“穿凿样”破坏及椎体的“扁平椎”是本病的特征性影像学征象。X线平片诊断价值有限,CT可清晰显示骨膜反应及骨质硬化,尤其是骨皮质细微的骨侵蚀。MR有助于显示X线及CT尚无异常表现的早期骨髓受累,并确定骨髓水肿及软组织病变范围。

Objective To dissuss the imaging features of solitary eosinophilic granuloma （EG） of bone in pediatrics. Methods A retrospective study on the imaging of 25 children with unifocal bone EG confirmed by histopathologic diagnosis from 2008 to 2015 was done. Results There were 19 male and 6 female patients, age range 2 - 14 years, mean age 6 years. Lesions were located in long bones （ 14）, the spine （6）, the skull （3）, the clavicle （ 1 ）, and the ilium （ 1 ）. The common imaging findings of the long bones included a bony destructive lesion with endosteal scalloping, periosteal reaction and soft tissue swelling or mass. Intracortical tunneling, sequestrums in lytic lesions and sclerotic margins were found in some cases. In the spine, the common imaing findings were a vertebral osteolytic lesion, results in collapse with a characteristic ＂vertebra plana＂ appearance. Paravertebral soft-tissue mass was found in some patients,with intervertebral disc space preservation. The lesions in skull had a characteristic ＂punched out＂ appearance with sharp borders, ＂button sequestra＂ and ＂beveled-edge＂ appearance were also found. The imaging findings of clavicle and ilium were non-specific. On MRI, lesions usually appeared isointense or hypointense at T1 weighted imaging, heterogeneously hyperintense at T2 weighted imaging. Conclusion ＂Intracortical tunneling＂ in long bones, ＂punched out＂ appearance in skull and ＂vertebra plana＂ in spine were characteristic imaging features of EG. The value of plain lms in the diagnosis of the EG is limited. CT scan clearly demonstrates periosteal reaction and osteosclerosis, especially small cortical ero- sion. MRI is helpful for showing early bone marrow lesions, while not seen that on X-ray and CT imagings, and also define; the extent of bone marrow edema and soft-tissue extension.