弥漫骨硬化的影像鉴别诊断陈恩明课件.ppt

1、2Sickle-cell disease:central endplate depression,secondary to infarction,resulting in H-shaped vertebral bodies.Medullary infarct within the proximal tibial metaphysis:plain radiograph andT1 W MRI.Well-defined lesion with sclerotic margins and patchy centralcalcification.On MRI this corresponds to a

2、 hyperintense lesion(marrow fat)with a well-defined peripheral low intensity(sclerotic)margin containingpunctate central low intensity(calcification).Large well-defined sclerotic infarct within the proximal femoral metaphysis.Venous stasis in a 22-year-old woman with swelling of the left lower leg.(

3、a)Radiographshows mature periostitis involving the medial cortex of the tibial diaphysis(arrowhead).Also noted is a phlebolith(arrow).(b)Oblique venogram shows a large venous varix close to the affected area of tibial cortex1213Engelmann-Camurati Disease：卡-恩二氏病（progressive diaphysial dysplasia，PDD）临

4、床及临床及X线特点线特点 骨斑点症具有以下特点骨斑点症具有以下特点:(1)本病无临床症状，均为查体或检查其它病时发现本病。(2)本病与年龄性别无关，文献报道年龄从4个月90岁均有发病。(3)病灶呈弥漫性多发的密度增大的圆形、椭圆形、圆圈状、结节状阴影，其形态走行，部分与骨的长轴一致。(4)病灶多累及长骨的两端，密集于干骺端及骨骺，以及骨盆、手、足及不规则骨。越靠近关节病灶越密集，且密度越浓。病灶可相互融合成片而遮盖正常骨组织。(5)密度增浓的斑点状病灶的边缘不甚清晰锐利，越靠近中心部位密度越浓，边缘部位密度略淡。骨斑点症骨斑点症(6)病灶侵及骨的松质骨。骨膜及关节软骨不受侵犯，故关节间隙光整清

5、晰。(7)本病应与成骨性转移相鉴别。成骨性转移首先应有原发性病灶并转移灶呈单发或散在多发性骨质增浓病灶，无密集对称性。其病灶直径均较大，直径一般在1.0cm以上，同时伴有明显的疼痛症状。与本病鉴别不难。还应与蜡泪样骨相鉴别。本症误诊的原因主要是临床及放射科医师对本病缺乏认识，未想到本病的可能。(8)骨斑点症是一种罕见的无害的骨质硬化性疾病，又称弥漫性致密性骨病、家族性弥漫性骨硬化症和点状骨。由Alber-shonberg于1915年首次报道。据统计发病率不足人群中的1/1000万。至今病因不明，从胎儿至69岁以下年龄段均有报道，可有家族史，具有遗传性，男性发病率高于女性。本病多无临床症状，实验

6、室检查无阳性。偶尔在放射线检查时被发现。Melorheostosis肢骨纹状肥大CT scan in a 47-year-old woman with TSC/LAM.Axial section at the T4 level viewed with bone windows demonstrates multiple sclerotic round bone lesions(arrows)in the vertebral body,right transverse process,and left rib注：tuberous sclerosis complex(TSC)complex wit

7、h lymphangioleiomyomatosis(LAM)CT scan in a 43-year-old woman with TSC/LAM.Axial section at the T8 level demonstrates rectangular-shaped SBLs conforming to the shape of the bones but not expanding them in the pedicle(white arrow),transverse process(arrowhead),and right rib(black arrow).Note three co

8、alescing round lesions in the anterior aspect of the vertebral body.CT scan in a 38-year-old woman with LAM.Axial section through the pelvis viewed with bone windows shows single fl ame-shaped lesion in theright iliac bone(arrow).良性脊索细胞瘤benign notochordal cell tumors(BNCTs)11-year-old girl with beni

9、gn notochordal cell tumor.Lesion was initially diagnosed as chordoma with atypical histopathologic features and surgical removal was performed.A,CT image shows mild osteosclerotic change in clivus without bone destruction or extraosseous extension(arrow).B,Axial fast spin-echo T2-weighted image(TR/T

10、E,4,000/96)shows slightly inhomogeneous hyperintensity(arrow).C,No contrast enhancement(arrow)is noted on spin-echo T1-weighted axial image(417/14)after IV injection of contrast materialBenign notochordal cell tumor in 63-year-old woman with neck pain.Bone metastasis was initially suspected,and open

11、biopsy was performed.A,Sagittal linear tomogram displays osteosclerotic change in posterior part of C3 vertebral body without bone destruction(arrow).B,Axial gradient-echo T2-weighted image(TR/TE,1,500/80)depicts slightly heterogeneous hyperintense lesion(arrow).C,No contrast enhancement(arrow)is no

12、ted on spin-echo T1-weighted axial image(420/80)after IV injection of contrast material.D,Photomicrograph of specimen reveals proliferation of vacuolated cells(arrows)between thickened bone frameworks(asterisks).No bone destruction or myxoid background is noted.(H and E,20)Benign notochordal cell tu

13、mor in 31-year-old man.Needle biopsy was performed due to coccydynia.A,Sagittal reformatted CT image shows mild osteosclerotic change in midline of S3 vertebral body without bone destruction(arrow).B,Sagittal fat-saturated contrast-enhanced spin-echo T1-weighted image(TR/TE,621/10)shows no contrast

14、enhancement corresponding to lesions(arrow).C,Sagittal fast spin-echo T2-weighted image(4,688/120)shows heterogeneous hyperintense lesion(arrow)8485 地方性氟中毒是以骨骼、牙齿损害为主的全身中毒性疾病。其中氟骨症除临床检查外，X线检查是简便易行、准确度高的方法，迄今为止尚未发现更为优越的检查手段，因而，X线检查被广泛用于氟骨症的诊断。氟骨症的诊断，一般根据流行病学资料及临床检查、化验、X线检查等综合考虑，但以X线检查为主。通过X线检查，可以对氟骨症进行分期，以了解罹患程度，能为好多临床现象提供合理的解释，为制定相应的治疗措施提供依据，还能对防治效果进行评价与动态观察。所以，在氟骨症的诊断与鉴别诊断中，X线检查是必不可少的一项内容。105107谢谢大家！