儿童颅骨筋膜炎的CT诊断及误诊分析  

CT diagnosis and misdiagnosis analysis of cranial fasciitis in children

作　　者：向永华[1] 金科[1] 周峥珍[2] 何四平[1] 李春旺[1] XIANG Yong-hua;JIN Ke;ZHOU Zheng-zhen(Department of Radiology,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院放射科,长沙410007 [2]湖南省儿童医院病理科,长沙410007

出　　处：《放射学实践》2023年第5期615-619,共5页Radiologic Practice

基　　金：湖南省自然科学基金面上项目(项目编号2022JJ30320)。

摘　　要：目的:总结儿童颅骨筋膜炎的临床及CT表现并分析误诊原因,提高对该病的诊断符合率。方法:回顾性分析2016年1月至2021年9月我院经手术病理证实的11例颅骨筋膜炎患者的临床及CT资料。结果:11例患儿中男4例,女7例,年龄5~107个月,平均年龄48.5个月。临床表现:无痛性肿块9例,2例肿块有压痛;肿块短期内明显增大2例,逐渐增大5例,无增大4例;病变单发9例,多发2例,多位于额顶枕部。CT表现分为两种:(1)6例表现为膨胀性溶骨性骨质破坏并软组织肿块,其中5例穿破颅板累及硬脑膜,4例可见残留骨片;(2)5例表现为头皮肿块并颅骨外板轻度侵蚀或受压。11例患儿的病变最大径为12~43 mm,软组织肿块CT平扫多呈等密度,边界清,增强可呈轻度至明显强化。11例CT均未诊断为颅骨筋膜炎,其中7例误诊为朗格汉斯细胞组织细胞增生症。结论:颅骨筋膜炎是一种罕见的累及头皮及颅骨的良性增生性病变,影像误诊率高,综合分析临床特点及影像征象,可提高诊断符合率。Objective:To summarize the clinical and CT findings of cranial fasciitis in children and analyze the causes of misdiagnosis,in order to improve the diagnostic accuracy of the disease.Methods:The clinical and CT data of 11 patients of cranial fasciitis confirmed by surgical pathology in our hospital from January 2016 to September 2021 were retrospectively analyzed.Results:Of these 11 patients,4 were male and 7 were female,aged from 5 to 107 months with an average age of 48.5 months.The clinical manifestations were as follows:painless mass in 9 cases,tenderness in 2 cases.In the short term,the mass increased significantly in 2 cases,gradually increased in 5 cases and did not increase in 4 cases.There were 9 cases of single lesion and 2 cases of multiple lesions,most of which were located in the frontoparietal occipital region.There were two types of CT findings:①6 patients presented with expansive and osteolytic bone destruction with soft tissue mass,of which,the lesions in 5 cases penetrated through the cranial plate involving dura,and residual bone fragments were observed in 4 cases.②5 patients presented with scalp mass with mild erosion or compression of the outer skull plate.The maximum diameters of the lesions in 11 patients ranged from 12 to 43mm.The soft tissue masses were usually isodensity with clear boundary on the plain CT,and mild to significantly enhanced on the contrast-enhanced CT.None of the 11 cases were diagnosed with cranial fasciitis by CT,and 7 of them were misdiagnosed as Langerhans cell histiocytosis.Conclusion:Cranial fasciitis is a rare benign hyperplastic lesion involving scalp and skull.The rate of imaging misdiagnosis is high.Comprehensive analysis of clinical features and imaging signs can improve the diagnostic accuracy.

关 键 词：颅骨筋膜炎 儿童 体层摄影术 X线计算机 误诊 

分 类 号：R726.8[医药卫生—儿科] R814.42[医药卫生—临床医学]