儿童颅骨筋膜炎的影像诊断及误诊分析  

Imaging diagnosis and misdiagnosis analysis of cranial fasciitis in children

作　　者：曾伟彬[1] 曹卫国[1] 张欢[2] 罗珍[3] ZENG Wei-bin;CAO Wei-guo;ZHANG Huan(Department of Radiology,Shenzhen Children's Hospital,Guangdong 518038,China)

机构地区：[1]深圳市儿童医院放射科,广东518038 [2]深圳市儿童医院病理科,广东518038 [3]深圳市儿童医院皮肤科,广东518038

出　　处：《放射学实践》2021年第7期920-924,共5页Radiologic Practice

基　　金：深圳市医疗卫生三名工程项目(SZSM202011005)。

摘　　要：目的:分析颅骨筋膜炎的影像表现及其误诊原因,提高对该病的诊断准确性。方法:回顾性分析10例经手术、病理证实的颅骨筋膜炎的临床资料及CT、MR影像资料,并复习相关文献。结果:10例患儿中男童7例,女童3例,年龄5~108个月,平均29.3个月,肿块大小约3~60 mm,临床表现为无痛性肿块。病变均位于颅骨,10例均行CT检查,2例行MR检查,头颅CT、MR显示颅骨筋膜炎影像表现有三种,分别是膨胀性骨质破坏,溶骨性骨质破坏,头皮包块。病变多数位于额颞顶部,软组织部分CT呈等密度影,边界清,部分病灶穿破颅板累及硬脑膜,MR表现为T1WI等信号,T2WI等/高信号,不均匀明显强化,DWI无扩散受限。影像诊断均未诊断为颅骨筋膜炎,2例误诊为嗜酸性肉芽肿,误诊为转移瘤、骨纤维结构不良、表皮样囊肿各1例,5例诊断意见性质待定。结论:颅骨筋膜炎是一种罕见的良性头皮颅骨肿物,易误诊,影像特点是常见于额颞顶部颅骨的骨质破坏。综合分析影像特点、临床特征可提高对该病的诊断准确性,通过手术切除即可治愈,避免过度治疗。Objective:To analyze the imaging manifestations of skull fasciitis and the causes of misdiagnosis,so as to improve the diagnostic accuracy of the disease.Methods:The clinical and imaging data of 10 patients with surgically and pathologically confirmed CF were retrospectively analyzed.Relevant literatures were reviewed.Results:Of these 10 cases,7 were male and 3 were female,aged from 5 to 108 months with an average age of 29.3 months.The maximum diameters of masses ranged from about 3 to 60 mm.The clinical manifestation was a painless mass in the skull.10 cases underwent CT scan and 2 underwent MR examination.There were three kinds of CF imaging characteristics revealed on cranial CT and MR,including expansive bone destruction,osteolytic bone destruction and scalp mass.Most of the lesions were located in the frontal,temporal and parietal regions.On CT,the soft tissue of CF was isodensity with well-defined edges.Some lesions penetrated through the entire cranial plate and even invaded the dura mater.MRI showed isointensity on T1WI,isointensity/hyperintensity on T2WI,inhomogeneous enhancement and no diffusion limitation on DWI.None of the 10 cases were diagnosed as CF.Two cases were misdiagnosed as eosinophilic granulomas,one case as metastatic tumor,one case as fibrous dysplasia,one case as epidermoid cyst and 5 cases remained as uncertainty.Conclusion:Cranial fasciitis is a rare benign scalp skull tumor which is easily misdiagnosed.The valuable imaging feature is bone destruction commonly found in the frontal,temporal and parietal bone.Comprehensive analysis of the imaging and clinical features can improve the diagnostic accuracy.Additionally,CF can be cured with surgical resection to prevent overtreatment.

关 键 词：颅骨筋膜炎 磁共振成像 体层摄影术 X线计算机 误诊 

分 类 号：R814.42[医药卫生—影像医学与核医学] R445.2[医药卫生—放射医学]