颌骨放射性骨坏死的影像学表现  

IMAGING FINDINGS OF OSTEORADIONECROSIS OF THE JAWS

作　　者：周锐志[1] 李彦磊 高炜 刘圆圆 陈海松[1] 郝大鹏[1] ZHOU Ruizhi;LI Yanlei;GAO Wei;LIU Yuanyuan;CHEN Haisong;HAO Dapeng(Department of Radiology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院放射科,山东青岛266003 [2]青岛市中心医院肿瘤内三科

出　　处：《青岛大学学报（医学版）》2021年第4期507-511,共5页Journal of Qingdao University(Medical Sciences)

基　　金：国家自然科学基金资助项目(81571673)。

摘　　要：目的总结颌骨放射性骨坏死(ORNJ)的影像学表现。方法将2009年5月—2019年5月就诊于我院并经临床病理检查证实为ORNJ的33例病人纳入研究。ORNJ按照临床表现分3期,Ⅰ期12例,Ⅱ期10例,Ⅲ期11例。回顾性分析ORNJ各期的影像学表现。结果X线表现:Ⅰ期示骨质多发透亮影伴骨小梁增粗、骨纹理模糊;Ⅱ期示骨质密度不均匀并明显降低;Ⅲ期示较大范围骨密度降低伴有游离死骨。CT表现:Ⅰ期示颌骨多发骨质密度减低区,脂肪间隙模糊,颈部多发小淋巴结;Ⅱ期示片状骨质破坏区、边缘不清,面肌间隙结构紊乱、软组织肿胀,乳突腔内软组织影,颈部多发小淋巴结;Ⅲ期示大范围溶骨性骨质破坏伴骨质硬化边及碎骨片影,软组织肿胀,颈部多发淋巴结大。结论ORNJ的Ⅰ期表现为多发斑片状的骨质破坏区,边界清;Ⅱ期的骨质破坏区范围扩大、边界不清,CT上呈现“虫洞状”改变;Ⅲ期出现死骨、病理性骨折及明显的溶骨性骨质破坏。总结其影像学表现,有助于本病诊断。Objective To summarize the imaging findings of osteoradionecrosis of the jaws(ORNJ).Methods A total of 33 patients who attended our hospital from May 2009 to May 2019 and were diagnosed with ORNJ based on clinical pathology were enrolled in this study,and according to the clinical manifestation,12 patients had stageⅠORNJ,10 had stageⅡORNJ,and 11 had stageⅢORNJ.A retrospective analysis was performed for the imaging findings of each stage of ORNJ.Results X-ray examination showed that stageⅠORNJ had multiple radiolucent shadow with thickened bone trabecula and vague bone texture;stageⅡORNJ had density heterogeneity of the bone with a significant reduction;stageⅢORNJ had a wide range of low density with free dead bone.CT examination showed that stageⅠORNJ had multiple low-density areas and fuzzy fat space in the jaw,as well as multiple small lymph nodes in the neck;stageⅡORNJ had patchy areas of bone destruction with unclear boundary,disordered structure of facial intermuscular space,soft tissue swelling,soft tissue shadow in mastoid cavity,and multiple small lymph nodes in the neck;stageⅢORNJ showed a large extent of osteolytic bone destruction with osteosclerosis and shadow of bone fragments,soft tissue swelling,and multiple enlarged lymph nodes in the neck.Conclusion StageⅠORNJ manifests as multiple patchy areas of bone destruction with clear boundaries;stageⅡORNJ has an enlarged area of bone destruction with unclear boun-dary and shows wormhole changes on CT;stageⅢORNJ has dead bone,pathological fracture,and obvious osteolytic bone destruction.A summary of imaging findings may help with the diagnosis of this disease.

关 键 词：放射性骨坏死 颌 放射摄影术 体层摄影术 X线计算机 病理学 临床 

分 类 号：R445.3[医药卫生—影像医学与核医学]