骨嗜酸性肉芽肿的影像学分析

Imaging Findings of Bone Eosinophilic Granuloma

目的探讨骨嗜酸性肉芽肿(EG)的临床、病理及影像学表现。方法回顾性分析经手术病理证实的15例骨EG患者的临床及影像学资料。结果15例骨EG中13例单发病灶,2例多发,共17处病灶,其中发生在颅骨7例、椎体3例、锁骨1例、骨盆2例、肋骨1例、长骨3例。颅骨病灶表现为侵犯颅骨内外板穿透性骨质破坏,可出现"双边征";椎体表现为楔形或扁平椎改变,可伴有周围软组织肿胀或脊髓受压,椎间隙不受累;长骨主要表现为溶骨性骨质破坏,部分边缘硬化,可见层样骨膜反应及"袖套征";骨盆、肋骨及锁骨表现缺乏特异性。病灶在CT上一般呈混杂密度肿块影,MRI上病灶为稍长T1、T2信号,周围伴有脊髓及软组织水肿,病灶内部有坏死。骨EG的病理表现为朗格汉斯细胞增生和炎性细胞的浸润。结论骨EG的影像学表现具有一定的特异性,综合其影像学表现、临床特征,有助于准确诊断。

Objective To investigate the clinical,pathological and imaging features of eosinophilic granuloma of bone(EG).Methods The clinical and imaging data of 15 patients with bone EG proved by surgery and pathology were analyzed retrospectively.Results Among the 15 cases of bone EG,there were 13 single lesions and 2 multiple lesions,with a total of 17 lesions,including 7 cases of skull,3 cases of vertebral body,1 case of clavicle,2 cases of pelvis,1 case of rib and 3 cases of long bone.The cranial lesions were characterized by penetrating bone destruction invading the inner and outer plates of the skull,and bilateral signs appeared.The vertebral body presents wedge-shaped or flattened vertebral changes,which may be accompanied by peripheral soft tissue swelling or spinal cord compression,and the intervertebral space is not involved.Long bone mainly presents as osteolytic destruction,partial marginal sclerosis,lamellar periosteum reaction and"sleeve sign"can be seen.Pelvic,rib and clavicular features lack specificity.Generally,the lesion presented mixed density mass shadow on CT,while on MRI,the lesion presented slightly longer T1 and T2 signals,with surrounding spinal cord and soft tissue edema,and necrosis inside the lesion.The pathological manifestations of bone EG were proliferation of langerhans cells and infiltration of inflammatory cells.Conclusion The imaging findings of bone EG have a certain specificity,which,combined with its imaging findings and clinical characteristics,is conducive to accurate diagnosis.