手部掌指骨与四肢长骨原发血管瘤的影像、临床及病理对照分析  

A radiologic-clinical-pathologic control study of primary bone hemangioma in the hand and long bones

作　　者：陈勇[1] 刘杰[1] 丁建平[1] 张泽坤[2] 

机构地区：[1]杭州师范大学附属医院放射科,浙江310015 [2]河北医科大学第三医院

出　　处：《中华手外科杂志》2015年第4期292-294,共3页Chinese Journal of Hand Surgery

基　　金：杭州市卫生科技计划一般A类项目（2014A17）;河北省卫生厅科研基金项目（20110395）

摘　　要：目的 探讨手部掌指骨与四肢长骨原发血管瘤的影像、临床及病理特征.方法 回顾性分析经手术后病理检查证实的9例掌指骨及8例四肢长骨血管瘤的影像和临床资料,并结合文献进行对比分析.17例均行X线检查,2例行CT检查,1例行MR[检查.结果 9例掌指骨血管瘤中髓型7例、骨膜型1例、皮质内型1例.8例四肢长骨血管瘤中髓型6例、骨膜型1例、皮质内型1例.髓型在掌指骨X线片显示为网格状骨纹,略膨胀;在长骨表现多样,可呈囊状、网格状或溶骨性改变.骨膜型在掌指骨及长骨X线片表现类似,均为皮质不规则增厚、硬化,及放射状骨膜新生骨.皮质内型在掌指骨及长骨X线片均表现为边界清晰的骨质破坏区,边缘轻度硬化;1例指骨皮质内型血管瘤的MRI表现为稍长T1WI,长T2WI信号,并夹杂少许低信号,病灶突破骨皮质,形成软组织肿块,邻近软组织内见迂曲血管影.结论 手部掌指骨及四肢长骨原发血管瘤的影像学表现较为相近,但长骨血管瘤表现更为丰富,典型表现均为网格状或囊状骨质破坏.影像学检查有助于显示病灶范围及周围肌肉侵犯情况,为临床诊疗及后期功能评估提供支持.Objective To study the radiologic,clinical and pathologic characteristics and diagnostie methods of primary bone hemangioma in the hand and long bones.Methods A retrospective review was conducted of 17 histologically confirmed primary bone hemangioma cases.Nine cases affected the hand while the other 8 cases the long bones of the extremities.The clinical,radiologic and pathologic characteristics were further analyzed and compared with those reported the literature.All 17 patients were examined with X-ray,while 2 patients had CT and 1 patient had MRI.Results Metacarpal and phalangeal hemangioma occurred in the bone marrow in 7 cases,in the periosteum in 1 case,and in the cortex in 1 case.Long bone hemangioma occurred in the bone marrow in 6 cases,in the periosteum in 1 case,and within the cortex in 1 case.When it occurred in the bone marrow cavity of metacarpals or phalanges,X-ray showed grid-like bone pattern and slight enlargement of the bone.When bone marrow of the long bones was affected,radiologic manifestations varied from cystic,gidlike to osteolytic changes.Similar X-ray findings were seen when hemangioma affected the periosteum of long bones and the metacarpals and phalanges,which included irregular cortical thickening,hardening,and radiating periosteal new bone formation.Lesions occurred in the cortex of metacarpals and phalanges and of long bones had similar X-ray characteristics：clearly demarcated bone destruction with slightly hardened edge.The MRI findings of hemangioma in the phalangeal cortex of 1 case showed longer T1WI signals and long T2WI signals mixed with a little low signal.The lesion penetrated the cortex and formed a soft tissue mass.Winding vascular sign could been seen in the adjacent soft tissues.Conclusion Imaging findings of primary hemangioma in metacarpals,phalanges and long bones are similar.Radiologic characteristics of long bone hemangiomas are more diverse,the typical ones being grid-like or cystic bone destruction.Imaging studies help to show the range of lesions and the exte

关 键 词：手 骨骼 血管瘤 诊断显像 

分 类 号：R732.204[医药卫生—肿瘤]