儿童朗格汉斯组织细胞增生症侵犯肋骨的X线与CT比较  

Comparison of X-ray and CT in evaluation of rib lesions in children with Langerhans cell histiocytosis

作　　者：胡培安[1] 施莺燕[1] 帕米尔[1] 李国平[1] 吕芸[1] 乔中伟[1] 

机构地区：[1]复旦大学附属儿科医院放射科,上海201102

出　　处：《肿瘤影像学》2014年第2期155-157,共3页Oncoradiology

摘　　要：目的回顾性分析15例儿童肋骨朗格汉斯组织细胞增生症（LCH）的X线和CT表现,以提高对该病认识。方法收集2012年1月—2013年6月经病理证实的儿童肋骨LCH患儿15例;所有患儿均行X线胸部正位片和胸部CT平扫检查,其中4例加行CT增强扫描。患儿发病年龄1个月-12岁,中位年龄3岁;男性9例、女性6例。分析所有患儿临床资料和影像学表现。结果 15例患儿中,8例临床表现为局部肿块,3例伴局部疼痛,其余病变无明显症状。7例表现为肋骨单发病灶,其中3例仅表现为肋骨病变、4例伴其他系统病变。8例为多发病灶,均伴发其他系统病变。15例共25个病灶中,胸片只发现19个;有2例共6个病灶胸片未发现明显病变。X线胸部正位片病灶检出率为76%。病灶在X线胸部平片上表现为边界清楚的骨质破坏。CT均表现为类圆形或多囊性膨胀性溶骨性骨质破坏;12个病灶（48%）可见硬化;3个（12%）伴软组织肿块,软组织肿块与骨病变伴行,增强后软组织肿块表现为明显强化。结论儿童肋骨LCH的X线胸部正位片检出率相对较低,需行CT对病变范围及周围组织器官侵犯情况进一步评价。发生在儿童肋骨的类圆形或多囊性、边界清楚的溶骨性骨质破坏,伴或不伴明显强化的软组织肿块,常提示LCH的诊断。Objective To retrospectively analyze X-ray photography and CT manifestations of rib Langerhans cell histiocytosis（LCH） in 15 children, and to improve the diagnostic accuracy. Methods From January 2012 to June 2013, 15 cases with rib LCH confirmed by pathology were collected and their clinical and radiological findings were analyzed. Their age ranged from one month to 12 years old and the median age was 3 years old. Nine of them were boys and six were girls. All the patients underwent both chest plain X-ray and CT scan, and four underwent additional contrast-enhanced CT（CECT）. Results Among 15 cases, 8 presented local masses, 3 had notable pain, and the other 7 cases had no symptoms. On X-ray/CT images, 7 cases manifested solitary rib lesions, 4 of them were accompanied with multi-organ lesions, and 3 of them had no other organs involved. 19 lesions in 13 cases were found on chest X-ray images, and 25 lesions were found on CT images. Six lesions in two patients found CT were found not on chest film. The positive percentage of chest X-ray examination was 76%（19/25）. On chest X-ray images, the lesions usually displayed well-defined osteolytic destruction of the rib. On CT images, all lesions showed multiple cysts or round-shape osteolytic destruction, 12 lesions（48%） with sclerosis margins, and 3 lesions（12%） with soft tissue masses which showed remarkable enhancement on CECT. Conclusion X-ray examination is less sensitive in the detection of the rib lesions. CT is necessary to evaluate the lesion range and the infiltration of adjacent tissues or organs. Welldefined round-like or multiple cystic osteolytic destruction in rib, with or without remarkable enhanced soft tissue masses, are suggestive of the diagnosis of LCH.

关 键 词：朗格汉斯组织细胞增生症 X线摄影术 计算机断层扫描 

分 类 号：R445.4[医药卫生—影像医学与核医学]