早期非创伤性骨化性肌炎的影像特点及分析  

Imaging Findings and Analysis of Early Non-traumatic Myostis Ossificans

作　　者：文星[1] 王蕾[1] 谢春汉[1] 欧阳志和[1] 晏正光[1] 肖立华[1] 舒花 

机构地区：[1]解放军169医院暨湖南师范大学附属湘南医院放射科,湖南衡阳421002

出　　处：《华南国防医学杂志》2017年第3期161-164,共4页Military Medical Journal of South China

摘　　要：目的探讨早期非创伤性骨化性肌炎(early non-traumatic myositis ossificans,ENMO)影像表现的特点。方法回顾性分析经病理证实的9例ENMO患者临床病理及影像检查资料。9例行核磁共振成像(magnetic resonance imaging,MRI)平扫和多时相增强扫描,电子计算机断层扫描(computed tomography,CT)平扫9例和增强扫描4例,数字化X线摄影(digital radiography,DR)检查9例,观察病变影像表现及强化特点。由2名高年资主治医师对影像资料共同进行分析。结果 X线平片显示ENMO多为关节附近软组织肿块(4例)、软组织周边密度增高(1例)、阴性(4例)。CT显示软组织肿块较X线清楚,肿块周围明显水肿(9例)及肿块中央液化及坏死(7例),肿块周边持续不规则强化(4例),1例可见新月状及蛋壳状钙化样影,邻近骨质及骨膜未见异常。MRI表现为9例病灶T1加权成像(T1-weighted imaging,T1WI)呈稍低信号,T2加权成像(T2-weighted imaging,T2WI)呈混杂信号,病灶中央坏死区明显呈高信号,灶周水肿区呈絮状稍高信号,肿块周围区呈较高信号;增强后肿块周边明显环状或片状不均匀持续强化(9例),病灶中心坏死区无强化,灶周水肿区轻度强化,呈现"晕征"。所有病例均经手术及病理证实。结论肿块周围带明显环状强化、环绕肿块周围软组织水肿带持续轻度强化所呈现的"晕征"、周围软组织明显广泛性渗出及水肿、X线检查所见肿块周围带"蛋壳"样钙化征,是ENMO MRI的影像特点,掌握这些特点有助于精准医疗。Objective To investigate imaging features of early non-traumatic myostis ossificans（ENMO）,and improve the accuracy of imaging diagnosis.Methods The clinical pathological and imaging data of 9 patients with ENMO were retrospectively analyzed.All of the nine patients underwent plain and contrast-enhanced magnetic resonance（MR）imaging,X-ray examination and computed tomography（CT）plain scan,while 4 of these patients had contrast-enhanced CT.The lesions imaging manifestations and characteristics were classified and analyzed with two high qualification doctors.Results The X-ray showed that 4 cases of ENMO were soft tissue mass near the joint,1 case showed peripheral soft tissue density increased and4 cases were negative.CT could show the soft tissue mass more clearly than X ray,which displayed obvious edematous around lump（9 cases）,the central liquefaction and necrosis（7 cases）,continuously irregular enhancement around the lump（4 cases）,crescent-shaped and eggshell-like calcification without any abnormalities of adjacent bone and periosteum（1 cases）.Magnetic resonance imaging（MRI）showed that 9 cases with low signal on T1WI and mixed signal on T2WI,the central necrotic area of lesions were observed as significantly high signal,lesions edema area were slightly flocculent high signal and the area around the masses were gently high signal.Contrast MR enhanced examinations showed obvious ring-like enhancement or uneven patches around masses,no central enhancement and slight enhancement in edema areas（halo sign）.All cases were proved by surgery and pathology.Conclusion The ring-like enhancement around masses,slight enhancement in edema areas（halo sign）around soft tissue near masses,the obvious extensive exudation and edema of peripheral soft tissue and the eggshell-like calcification are MRI imaging features of ENMO,which can help us for medical applications.

关 键 词：骨化性肌炎 肿瘤 磁共振成像 放射摄影术 横纹肌肉瘤 

分 类 号：R685.2[医药卫生—骨科学]