四肢骨骨脓肿的影像学表现  

Imaging findings of bone abscess in extremities

作　　者：张玉光 李永胜 崔久法[2] 刘吉华[2] 李书强 高会艳 孙盼 ZHANG Yuguang;LI Yongsheng;CUI Jiufa;LIU Jihua;LI Shuqiang;GAO Huiyan;SUN Pan(Department of Radiology,Chengyang People's Hospital of Qingdao,Qingdao,Shandong Province 266109,China;Department of Radiology,the Affiliated Hospital of Qingdao University,Qingdao,Shandong Province 266003,China)

机构地区：[1]青岛市城阳人民医院放射科,山东青岛266109 [2]青岛大学附属医院放射科,山东青岛266003

出　　处：《实用放射学杂志》2021年第9期1512-1515,1520,共5页Journal of Practical Radiology

摘　　要：目的探讨四肢骨骨脓肿的影像学表现及特征.方法回顾性分析34例经手术病理证实的四肢骨骨脓肿患者的X线、CT和MR征象并进行总结.结果X线和CT上,骨质破坏大部或全部边界清楚,33例主要位于松质骨或骨干髓腔,1例主要位于骨皮质.4例骨破坏呈哑铃形或串珠状,2例为条柱状,1例为不规则形,3例为相邻多灶.29例骨破坏区伴骨硬化缘,20例骨破坏周围伴斑片状硬化,4例显示死骨.4例有骨内窦道.9例出现骨膜增生,6例显示皮质增厚.MR上,32例骨内病灶中,与肌肉相比T_(2)WI或脂肪抑制T_(2)WI均呈均匀或不均匀水样高信号,T_(1)WI23例为低信号,9例为略高信号.8例扩散加权成像(DWI)全部或大部呈明显高信号.14例骨内病灶显示短T_(1)信号,6例增强者中3例略强化.22例骨内病灶边缘有长T_(1)短T_(2)信号.2例显示骨内窦道.32例病灶周围均有骨髓水肿.10例显示周围软组织肿胀.结论四肢骨骨脓肿影像学表现可提示诊断,其中边界清楚的相邻多灶及特殊形态骨质破坏、骨内病灶边缘短T_(1)信号、DWI高信号、边界清楚的高密度死骨、骨内窦道等征象具有很高的特异性.Objective To investigate the imaging features and characteristics of bone abscess in extremities.Methods The X-ray,CT and MR features of 34 cases with bone abscess in extremities comfirmed by operation and pathology were retrospectively analyzed and reviewed.Results On X-ray and CT,well-defined bone destruction areas appeared in almost all the cases.33 cases were mainly located in the cancellous bones or the medullary cavity of the diaphysis,and 1 case was located in the bone cortex.4 cases showed dumbbell-like or string beads shape,2 cases showed strip-like shape,1 case appeared irregular shape,and 3 cases showed adjacent multiple foci.A peripheral sclerotic margin was displayed in 29 cases.Peripheral patchy sclerosis appeared in 20 cases.Sequestra appeared in 4 cases.Intraosseous sinus tracts were showed in 4 cases.Periosteal reaction and cortical thickening appeared in 9 cases and 6 cases,respectively.On MR,32 cases showed homogeneous or heterogeneous water-like hyperintensity on T_(2)WI or fat suppression T_(2)WI,23 cases showed hypointensity and 9 cases showed slightly high signal on TjWI.as compared to the signal of skeletal muscles.All 8 cases with diffusion weighted imaging(DWI)performed showed obviously high signal.The hyperintensity rim on TiWI appeared in 14 cases.3 cases showed slight enhancement among the 6 enhanced-MRI performed cases.The peripheral low signal line on TiWI and T_(2)WI appeared in 22 cases.Intraosseous sinus tracts were displayed in 2 cases.Bone marrow edema around the lesions appeared in 32 cases.Soft tissue swelling was presented in 10 cases.Conclusion Bone abscess in extremities can be diagnosed by imaging features.Well-defined,adjacent multiple foci,special shape of bone destruction,peripheral low signal line on TiWI,high signal on DWI,well-defined high-density sequestra and intraosseous sinus tracts may be specific signs for the diagnosis of bone abscess.

关 键 词：骨脓肿 计算机体层成像 磁共振成像 

分 类 号：R681.2[医药卫生—骨科学] R681[医药卫生—外科学]