4骨肌影像诊断摘要--陈恩明20160908-0923.ppt

* * * * 钮扣样死骨：Eosinophilic granuloma in a 16-year-old boy with pain in the right calf. Oblique (a) and anteroposterior (b) radiographs show a central osseous area of increased opacity (arrow) surrounded by lysis, the so-called button sequestrum. This finding is rarely seen in the long bones, being more typical in skull lesions of eosinophilicgranuloma. Also note the subtle periostitis on the anteroposterior radiograph (b) 骨嗜酸性肉芽肿：钮扣征。但应注意亦可见于TB、转移瘤、放射性骨坏死 Hemangioma in a 40-year-old woman who experienced minor trauma. Radiograph shows an eccentric focus of osteolysis in the middiaphysis with a coarse trabecular appearance. Latticelike（格子样）trabeculae, which are commonly seen in the skull, can suggest the diagnosis of hemangioma 良性纤维组织细胞瘤 又称黄色瘤或纤维黄色瘤，极少见，肿瘤起源于间充质细胞，主要成分是组织细胞和纤维母细胞。 临床表现：多见于成人【但有报道10-15岁，3-20岁多见】，以长管状骨多见。持续的局部严重疼痛，轻度肿胀。X线表现????位于长骨骨干或干骺端，呈偏心性溶骨性破坏。皮质骨膨胀变薄，周围有明显的粗糙不规则的硬化，无骨膜反应。发生在扁平骨者，硬化骨呈环状。类似于组织细胞纤维瘤和骨巨细胞瘤 MRI：T2WI瘤灶多区域信号低【见上海市一病例50岁】 鉴别：非骨化性纤维瘤：???多为儿童及青年，无明显症状，多因病理骨折才就诊，几乎均发生在干骺端，两者病理表现相似，主要根据临床及X线鉴别。 M 55y。左股骨下端疼痛十余天 M,55Y,右髋痛，跛行，术前股骨头坏死，术中转移瘤，PATH纤维组织细胞瘤 History:??Male teenager with pain Fibroxanthoma（纤维黄色瘤=良性纤维组织细胞瘤） with pathologic fracture 【与非骨化性纤维瘤鉴别：有无疼痛是要点，影像呈NOF伴明显疼痛的，应考虑纤维黄色瘤】 Fibroxanthomas are eccentric intramedullary lesions extending to the cortex with a classic superficial scalloping contour, never abutting the physis（生长板） Histologically they are benign, and contain spindle shaped fibroblasts oriented in a cartwheel pattern with scattered giant cells, foam cells, and collagen. By definition, these lesions measure greater than 3 cm. When less than 3 cm, the lesion is called a fibrous cortical defect (FCD). Although histologically identical, FCD lesions are more likely to remain asymptomatic and resolve spontaneously. Most commonly occurs between age 10 -15, age range 3 -20. Male to female ratio 2:1.? 90 % involve long tubular bones. Common sites include the distal femur (38%) and proximal or distal tibial metaphysis (43%).?