颅盖孤立性病变的影像学分析

Radiographic features of calvarial solitary lesion

目的探讨颅盖孤立性病变的影像特征与临床病理特点,提高鉴别诊断水平。方法回顾性分析经手术病理证实的17例资料完整的颅盖孤立性病变患者的临床资料。结果 17例患者中,良性病变11例(骨瘤、动脉瘤样骨囊肿、表皮样囊肿及嗜酸性肉芽肿各1例,骨纤维异常增殖症2例,脑膜瘤5例),恶性病变6例(血管肉瘤3例,间叶性软骨肉瘤、浆细胞骨髓瘤及转移瘤各1例)。结论影像方法尤其是CT、MRI能清晰显示病变的大小、形态及周围组织浸润程度;良性病变多病史较长、增长缓慢,边界清楚、形态较规则,局部脑颅骨多为增厚或膨胀性改变、骨质缺损区边缘锐利、部分见硬化边,且邻近软组织常无明显异常改变;而恶性病变则呈浸润性生长、边界不清,易侵犯周围软组织伴肿块形成,增强扫描呈不均匀强化,术后短期内复发;部分病变与良恶性肿瘤及感染性病变鉴别诊断存在一定的困难,确诊需结合影像、临床和病理。

Objective To improve the differential diagnosis of calvarial solitary lesion by analyzing their radiological features. Methods Seventeen patients with calvarial solitary lesion were analyzed retrospectively. Results Solitary lesions of the calvaria carried a broad differential diagnosis, including 11 cases of benign pathologies（4 cases of osteoma, aneurysmal bone cyst, epidermoid cyst and eosinophilic granuloma respectively, as well as 2 cases of fibrous dysplasia and 5 cases of meningioma）, and 6 cases of malignant pathologies（3 cases of angiosarcoma, and 3 cases of mesenchymal chondrosarcoma, plasma cell myeloma and metastatic tumors respectively）. Conclusion Conventional radiography contributes to characterizing calvarial solitary lesion. Benign ones always have long history, sharply defined margins, regular shape, adjacent skull thickening or swelling without obvious involvement of adjacent soft tissue. While malignant ones show bone destruction with accompanying soft tissue opacity, scalp swelling, intracranial involvement, inhomogeneous enhancement and short-term recurrence after operation. As it is difficult to differentiate these lesions, diagnosis should be based on radiographic and clinical features as well as histopathology finding.