骨化性肌炎的多模态影像学表现

Multimodal imaging manifestations in ossifying myositis

目的:探讨骨化性肌炎的X线、CT、MRI、SPECT/CT的特征性表现。方法:回顾性分析56例经病理或随访证实为骨化性肌炎患者的影像学资料,总结其影像学特征,探讨该病的鉴别要点及诊断价值。结果:56例中,位于髋关节23例,肘关节18例,其他部位15例。早期病变12例,CT或MRI表现为软组织水肿、肿胀,无明显骨化成分,可合并邻近骨骼的骨膜反应;中期病变23例,表现为软组织内分层状肿块,病灶中心呈软组织密度或信号,病灶周围呈蛋壳样、絮状骨化影,SPECT/CT表现为病灶整体显像剂异常摄取;晚期病变21例,表现为边界清楚的骨化团块,SPECT/CT显像15例,其中3例未见显像剂摄取,6例病灶中央显像剂摄取,6例病灶周围显像剂不均匀摄取。结论:骨化性肌炎早期缺乏影像学特征,中期蛋壳样骨化是其特征表现,晚期的骨化团块可表现为不同形式的显像剂摄取,多模态影像学的综合应用可提高其临床诊断价值。

Objective:To explore the main points of differential diagnosis and diagnostic value of ossifying myositis in X-ray,CT,MRI and SPECT/CT manifestations.Methods:The imaging data of 56 patients with ossifying myositis confirmed by pathology or follow-up were analyzed retrospectively,the imaging characteristics were summarized,and the identification points and diagnostic value were discussed.Results:56 cases of ossifying myositis were located in 23 cases of hip joint,18 cases of elbow joint,and 15 cases of other parts.In 12 cases of early lesions,MRI or CT showed soft tissue edema and swelling,and may be combined with the periosteal reaction of adjacent bones,no obvious ossification existed.23 cases of medium-term lesions,which showed stratified mass in soft tissue,soft tissue density or signal in the center,eggshell-like,flocculent ossification around the lesion,and SPECT/CT showed abnormal uptake of the overall imaging agent of the lesion.21 cases of advanced lesions showed clear ossified masses,and 15 cases had SPECT/CT imaging,among them,3 cases had no imaging agent uptake,6 cases had central imaging agent uptake,and 6 cases had uneven imaging agent uptake around the lesion.Conclusions:Ossifying myositis lacks imaging features in the early stage,and eggshell-like ossification is the characteristic manifestation of the middle stage.Advanced ossification masses can be represented by different forms of imaging agent uptake,and the comprehensive application of multimodal imaging can improve the clinical diagnostic value.