儿童颅骨筋膜炎的临床及影像学特征

Clinical and Imaging Features of Cranial Fasciitis in Children

目的:探讨儿童颅骨筋膜炎(CF)的临床及影像学特征,旨在提高对其认识。方法:回顾性分析、总结经本院手术及病理证实的13例颅骨筋膜炎的临床及CT、MRI资料,13例患儿行CT检查,3例行MRI检查,其中1例CT及MRI增强检查,手术切除后进行了8~61个月随访。结果:13例CF中,男7例,女6例,年龄3个月~12岁8个月,平均46.7个月。13例均表现为质硬、无痛且活动性差的头皮肿块。短期内,2例(15.4%)体积迅速增大,6例(46.2%)缓慢增大。CT表现分为三型:Ⅰ型(7例,53.8%)表现为膨胀性溶骨性骨质破坏伴软组织肿块;Ⅱ型(2例,15.4%)表现为非膨胀性溶骨性骨质破坏伴软组织肿块;Ⅲ型(4例,30.8%)表现为头皮肿块压迫相邻颅骨,颅骨受压变薄/吸收破坏。13例中,12例软组织包块为等或稍高密度,1例为低密度,包块边界清晰。3例行MRI检查患儿中,1例软组织包块信号均匀,2例不均匀,其中1例行增强扫描后呈环形增强。随访中4例(30.8%)复发。结论:CF是发生于儿童头皮或颅骨的无痛性的良性包块,质硬、活动度差,体积多缓慢或快速增大。CT表现分为3种类型:膨胀性溶骨性骨质破坏伴软组织肿块;非膨胀性溶骨性骨质破坏伴软组织肿块;头皮软组织包块伴骨质受压变薄/吸收破坏。软组织肿块密度及信号多变。手术后较易复发,建议扩大手术切除范围。

Purpose:To summarize the clinical and imaging characteristic features of cranial fasciitis(CF)in children,in order to improve the knowledge of radiologists and clinicians.Methods:The clinical,CT and MRI data of 13 CF patients confirmed by surgery and pathology in our hospital were analyzed and summarized retrospectively.Thirteen patients underwent a plain CT scan of the head,3 patients underwent a plain MRI scan,and 1 patient underwent CT and MRI enhancement examination.After surgery,they were followed up for 8 to 61 months.Results:The 13 CF patients(7 males and 6 females)aged 3-152 months,with an average of 46.7 months.All the 13 patients presented hard,painless and firm masses at the lesion position.In the short term,the mass increased rapidly in 2 patients(15.4%),and increased slowly in 6 cases(46.2%).The lesions were divided into three types based on CT findings:typeⅠ(7 cases,53.8%)presented as expansive and osteolytic bone destruction with a soft tissue mass;typeⅡ(2 cases,15.4%)presented as unexpansive and osteolytic bone destruction with a soft tissue mass;typeⅢ(4 cases,30.8%)presented as a scalp mass with pressure or erosion of the skull.On CT,the soft tissue masses of 12 patients were isodensity or slightly high density,and 1 was low density,of which were all with well-defined edges.On MRI,the soft tissue mass of 1 patient was homogeneous and the other 2 were heterogeneous,of which 1 patient presented circular enhancement in the MRI enhancement examination.Four patients(30.8%)recurred during follow-up.Conclusions:CF is a painless,hard and nonmobile benign mass on the scalp or skull in children.The mass can slowly or rapidly increase in a short term.CF can be divided into three types:expansive and osteolytic bone destruction with a soft tissue mass,unexpansive and osteolytic bone destruction with a soft tissue mass,a scalp soft tissue mass with bone compression thinning/absorption.The density and signal of the soft tissue masse is variable.CF is easy to recur after surgery,so we recommend an aggressive resection in order to reduce the recurrence rates.