纤维性骨皮质缺损的X线与CT诊断

X-ray and CT Diagnosis of Fibrous Cortical Defect of Bone: An Analysis of 21 Cases

目的 提高对纤维性骨皮质缺损 (FCD)的影像诊断和鉴别诊断能力。资料与方法 搜集经临床追踪诊断或手术病理确诊的有X线和 /或CT检查资料的纤维性骨皮质缺损病例 ,2 1例均有X线资料 ,其中 6例有CT资料。重点进行影像诊断分析。结果 2 1例共 2 8个病灶 ,其中股骨远端 18个 ,胫骨近端 5个 ,股骨近端 2个 ,腓骨近端 2个 ,尺骨 1个 ;单发 16例 ,多发 5例 ;长骨干骺部 2 5个 ,骨骺边缘 3个。X线表现 :大小为 0 .5～ 3.2cm ,平均1.2 5cm。圆形 7个 ,椭圆形 15个 ,长径均与长骨一致 ,不规则 6个 ;边界清晰 2 4个 ,模糊 4个 ;2 2个可见硬化边 ,边厚约 1mm ,6个未见硬化边。病灶内为均匀的低密度 ,周围未见骨膜反应及软组织肿胀。 7个病灶CT表现 :位于骨皮质内 ,轻度向外膨胀 1个 ,3个皮质凹陷 ,3个膨入髓腔 ;周围硬化环均完整连续 ;环内为均匀的软组织密度 ,均未见钙化灶 ,2个病灶内可见很细的纵向间隔 ;2个病灶邻近有轻微软组织肿胀 ,5个邻近无软组织肿胀。 10个病灶经随访观察 ,无 1例发现病灶扩大或出现新病灶 ,2个病灶无改变 ,8个病灶可见不同程度的缩小。结论 典型的FCD单凭X线即可诊断 ,否则应结合发病年龄、临床表现、X线表现及随访改变等综合考虑 ,CT检查对病变的定位非常明确 ,对骨皮质的连续性、?

Objective To make a further understanding of the imaging diagnosis and differentiation of fibrous cortical defect of bone (FCD).Materials and Methods Twenty-one cases of pathologically-confirmed FCD were collected. All cases had conventional X-ray films and six cases had CT scans in addition. The analysis was focused on the imaging features.Results Total 28 lesions were found in 21 cases, of which the lesion was located at distal femur in 18, at proximal tibia in 5, at proximal femur in 2, at proximal fibular in 2 and at ulna in one. Multiple lesions were seen in 5 patients, while single lesion in 16. The lesion was situated at metaphysis in 25 cases and at the rim of epiphysis in 3. On radiographs, The lesion's size was 0.5～3.2cm with an average of 1.25cm. The lesion's shape was round in 7, oval in 15 and irregular in 3. The lesion's margin was sharp in 24 and blurred in 4. Sclerotic rim sign occurred in 22 lesions. The lesion showed even low-density without periosteal reaction nor soft tissue swelling around. On CT scan, all 7 lesions were located within cortical bone, showing the signs of slight expansion (n=1), cortical hollow (n=3) or protrusion into medullary cavity (n=3). Intact sclerotic ring was seen in all lesions, and the soft tissue within the ring was even in density without calcifications. Fine longitudinal septum was seen in 2 lesions, and slight soft tissue swelling nearby was found in 2. During following-up period, neither enlargement of the lesion nor newly-developed lesion occurred, and regression of the lesion in some extent was seen in 8, and 2 lesions remained the same.Conclusion Typical FCD can be diagnosed by conventional radiography alone, otherwise, the patient's age, clinical manifestation, X-ray findings and the clinical course should be taken into account altogether. CT scan is superior to conventional radiography in displaying the cortical continuity, expansion, soft tissue swelling, periosteal reaction, lesion's density and sclerotic rim sign.