骨肌系统肉芽肿性炎19例的MRI表现

MRI manifestation of granulomatous inflammation of the musculoskeletal system

目的探讨骨肌系统肉芽肿性炎的MRI表现。方法回顾性分析19例经病理证实的骨肌系统肉芽肿性炎的MRI表现。结果 (1)病灶发生在不同部位,其中颈部1例,胸腰椎4例,手腕3例,骶髂关节1例,髋关节1例,大腿1例,膝关节2例,小腿3例,足踝3例。19例患者中,病变累及骨骼10例,肌肉14例,同时累及骨骼和肌肉5例。(2)病灶单发14例,形态不规则13例,边界不清13例。(3)病灶在T1WI呈不均匀等、低信号16例,稍高信号3例;在T2WI呈不均匀高信号17例,不均匀等、低信号2例;增强后病灶不均匀强化10例。(4)不规则骨质破坏10例,关节面破坏5例,椎间盘破坏4例,椎体压缩性骨折2例。(5)病灶周围软组织肿胀13例,脓肿形成3例,病灶内见坏死区2例,病灶突入椎管压迫硬膜囊和脊髓3例。(6)4例发生在肌肉内的病灶呈条带状沿肌纤维方向分布,其中1例信号均匀,3例呈中间低信号,外周高信号。结论骨肌系统肉芽肿性炎的MRI表现有一定的特征性。MRI对肉芽肿性炎诊断具有一定的价值。

Objective To explore MRI manifestation of granulomatous inflammation of the musculoskeletal system. Methods A retrospective analysis was made on the MRI manifestation of the 19 patients with granulomatous inflammation confirmed by histopathology. Results( 1) Lesions were found in different sites,with 1 case in the neck,4 cases in the thoracolumbar region,3 cases in the wrist,1 case in sacro-iliac joint,1 case in the hip joint,1 case in the thigh,2 cases in the knee joint,3 cases in the lower leg and still another 3 cases in the ankle. Of the 19 patients,10 were affected in the skeletal system,14 were affected in the muscular system,and 5 were simultaneously affected in the musculoskeletal system.( 2) There was single lesion in 14 patients,of which 13 displayed irregular morphology and another 13 displayed unclear boundary.( 3) The lesion in T1 WI displayed heterogeneity,with low signal in 15 cases and relatively high signal in 3 cases. The lesion in T2 WI displayed heterogeneity in 17 cases,with heterogeneity and low signal in2 cases. And there were 10 cases that displayed heterogeneity after enhancement.( 4) Irregular bone destruction was found in 10 cases,with 5 cases at the articular surface,4 cases at intervertebral disc and 2 cases with vertebral compression fracture.( 5) There were 13 cases of adjacent soft tissue swelling,with 3 cases of abscess,2 cases of necrosis in the lesion and 3 cases of epidural and spinal canal compression due to lesion intrusion into the spinal canal.( 6) There were 4 cases of lesion with strip distribution along the muscle,with uniform signal in 1 case,moderate and peripheral high signals in 3 cases. Conclusion MRI manifestations of granulomatous inflammation of the musculoskeletal system had certain features,which were valuable for the diagnosis of granulomatous inflammation.