长骨皮质型骨样骨瘤的影像学表现与鉴别诊断  

Imaging manifestations and differential diagnoses of cortical osteoid osteoma in the diaphysis of long bones

作　　者：张殿星 孙博 巩武贤 黄世廷 田军 ZHANG Dianxing;SUN Bo;GONG Wuxian;HUANG Shiting;TIAN Jun(Department of Medical Imaging,Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属省立医院医学影像科,山东济南250021

出　　处：《医学影像学杂志》2024年第10期120-124,共5页Journal of Medical Imaging

基　　金：山东省科技成果转移转换补助(鲁渝科技协作)项目[编号:(2023)-115]。

摘　　要：目的探讨长骨皮质型骨样骨瘤的影像学表现及其与骨母细胞瘤、迁延性灶性坏死性疲劳骨折及慢性皮质型骨髓炎的鉴别诊断。方法选取临床随诊或病理学证实的33例长骨皮质型骨样骨瘤患者的影像学资料,其中行X线平片检查18例,行CT检查26例,行MRI检查10例,其中增强MRI扫描2例。由2位资深影像科医师分别阅片。结果X线平片检查显示瘤巢14例、中央区钙化6例;CT检查显示瘤巢25例、中央区钙化22例;MRI检查显示瘤巢10例、中央区钙化8例。瘤巢呈圆形5个、卵圆形21个、枣核状7个。皮质“实性”增厚者8例,“皮质软化”性增厚者25例,3例皮质呈双翼征增厚,增厚的皮质或(和)骨质硬化区内出现“血管沟征”22例。结论长骨皮质型骨样骨瘤瘤巢多呈平行于骨干长轴的卵圆形或枣核状,瘤巢周围伴有特征性的皮质增厚、髓腔内反应性骨硬化、骨髓与软组织水肿,“皮质软化”征与“血管沟”征是长骨皮质型骨样骨瘤重要的影像学征象。Objective To explore the imaging features of cortical osteoid osteoma in the diaphysis of long bones and its differential diagnoses from osteoblastoma,persistent focal necrotizing fatigue fracture,and chronic cortical osteomyelitis.Methods A retrospective analysis was conducted on the imaging manifestations of 33 cases of cortical osteoid osteoma in the diaphysis of long bones confirmed by clinical or pathological examination.Among them,18 cases underwent X-ray plain film examination,26 cases underwent X-ray computed tomography(CT)examination,10 cases underwent Magnetic resonance imaging(MRI)examination,and 2 cases underwent enhanced MRI scanning.Two senior radiologists reviewed the film separately.Results Plain radiographs showed 14 nodules and 6 calcifications in the central region of the 18 patients.CT examination showed 25 nodules and 22 calcifications in the central region of 26 patients.MRI examination showed that 10 patients had 10 tumor nests with 8 central calcifications.There were 5 rounded,21 oval and 7 jujube shaped tumor nests.There were 8 cases of"solid"cortical thickening,25 cases of"cortical softening"cortical thickening,and 3 cases of cortical biplane thickening.Twenty-two cases of"vascular groove sign"appeared in the thickened cortex or/and osteosclerosis area.Conclusion The nests of cortical osteoid osteoma in the diaphysis of long bones are mostly oval or jujube shaped,parallel to the long axis of the shaft.The nests are accompanied by characteristic cortical thickening,reactive bone sclerosis in the medullary cavity,bone marrow and soft tissue edema.Cortical softening sign and vascular groove sign are the significant imaging features of cortical osteoid osteoma in the diaphysis of long bones.

关 键 词：骨样骨瘤 皮质型 X线平片 体层摄影术 X线计算机 磁共振成像 

分 类 号：R683.42[医药卫生—骨科学] R445[医药卫生—外科学]