骨嗜酸性肉芽肿的影像学分析

Imaging Analysis of Eosinophilic Granuloma of Bone

目的 探讨骨嗜酸性肉芽肿的影像学表现。资料与方法 回顾分析经病理证实的骨嗜酸性肉芽肿 18例 ,其中X线平片检查 16例 ,CT检查 10例 ,MRI检查 4例。结果 颅骨 6例 ,表现为圆形、类圆形骨质破坏伴颅板内外软组织肿块 ;脊椎 5例 ,椎体不规则破坏 ,边缘硬化 ,楔形变 ,椎旁软组织肿块 ,严重者椎体压缩呈盘状 ;肋骨 2例 ,穿凿样或膨胀性骨质破坏 ;肩胛骨 1例 ,斑片状骨质破坏伴周围广泛增生 ,有骨膜反应 ;股骨 4例 ,膨胀性或溶骨性骨质破坏伴骨膜反应。MRI表现 :T1WI呈低或等信号 ,T2 WI高信号 ,STIR高信号 ,增强明显强化。 18例中正确诊断 12例 ,诊断准确率 6 6 .7%。结论 通过影像学检查 ,并结合临床 ,大部分骨嗜酸性肉芽肿术前能够正确诊断 ;CT较X线平片能更好地显示病变结构及邻近软组织的改变 ;

Objective To explore the imaging manifestations of bone eosinophilic granuloma.Materials and Methods Imaging findings, including plain film (n=16), CT scans (n=10) and MRI (n=4), in 18 patients with pathologically confirmed bone eosinophilic granuloma were retrospectively analyzed.Results Of 18 cases, the lesion was located in skull in 6, presenting as round or oval osteolytic destruction with soft tissue mass at inner and outer table. The lesion occurred at vertebra in 5 cases, displaying as irregular bony destruction, rim osteosclerosis and wedge formed vertebral body with paravertebral mass. The lesion lay in the rib in 2 cases, manifesting itself as punched out or expansive bone destruction with a sharp border. The scapula was involved in one case with the lesion making its appearance as patch bony destruction with marginal osteosclerosis and periosteal reaction. The femur was affected in 4 cases and the lesion was characterized by expansive or osteolytic bony destruction with periosteal reaction. On MRI, the lesion showed low or iso signal on T 1WI, while high signal on T 2WI and STIR, with marked enhancement after Gd DTPA injection. Correct diagnosis was established in 12 patients (66.7%) based on imaging signs.Conclusion By the combination of imaging examination with clinical data, correct diagnosis of bone eosinophilic granuloma can be established in most patients. CT is superior to plain radiography in displaying the structure of the diseased bone and its neighboring soft tissue, and MRI can precisely reveal the lesion's extent.