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目的探讨良性骨病变在影像学上出现的侵袭性征象及其对诊断的影响。方法回顾影像学上有侵袭性征象并经手术病理或临床随访证实的良性骨病变患者资料200例,所有病例均行X线平片检查,其中177例行CT平扫,103例行MRI平扫,三种检查方法齐全者89例。统计侵袭性征象,主要包括周围骨髓与软组织水肿,有占位效应的异常软组织影,不连续的骨膜反应,骨皮质的中断与病理性骨折,类似瘤骨的软组织内钙化骨化或残余骨质。计算三种影像学方法对各病例的诊断与病理的符合率,并做统计学分析。结果出现骨髓及周围软组织水肿的病例中,骨母细胞瘤9例,软骨母细胞瘤6例,骨样骨瘤9例,Langerhans细胞组织细胞增生症17例,疲劳骨折18例,骨结核25例,不典型骨髓炎7例。出现异常软组织影的病例中,骨母细胞瘤7例,软骨母细胞瘤1例,Langerhans细胞组织细胞增生症15例,骨结核17例。出现不连续骨膜反应的病例中,其中骨样骨瘤1例,Langerhans细胞组织细胞增生症3例,疲劳骨折3例,骨结核1例,不典型骨髓炎3例。出现骨皮质的中断及病理骨折的病例中,骨母细胞瘤7例,软骨母细胞瘤3例,骨样骨瘤4例,Langerhans细胞组织细胞增生症26例,疲劳骨折14例,骨结核28例,不典型骨髓炎4例。出现类似瘤骨的软组织内钙化骨化或残余骨质的病例中,骨母细胞瘤1例,软骨母细胞瘤2例,Langerhans细胞组织细胞增生症2例,骨结核5例。对于良恶性符合率及病理符合率,CT均略高于MRI(P<0.05),三种影像学方法的综合应用,可以明显提高诊断符合率(P<0.05)。结论许多良性骨病变可伴发侵袭性征象,给诊断带来困难。联合应用三种影像学方法综合判断,是避免误诊为恶性肿瘤的最简单可行的办法。
Objective To investigate the imaging features of benign bone lesions and its impact on diagnosis. Methods The data of 200 patients with benign bone lesions who had invasive signs and were confirmed by operation pathology or clinical follow-up were retrospectively reviewed. All the cases were examined by X-ray plain film, of which 177 were plain CT scan and 103 were plain MRI scan , Three kinds of examination methods are complete in 89 cases. Statistical invasion of signs, including the surrounding bone marrow and soft tissue edema, with the effect of abnormal soft tissue lesions, discontinuous periosteal reaction, cortical bone fracture and pathological fracture, similar to the soft tissue calcification ossification or residual bone . The coincidence rates of the three imaging methods in diagnosis and pathology of each case were calculated and statistically analyzed. Results There were 9 cases of osteoblastoma, 6 cases of osteoblastoma, 9 cases of osteoid osteoma, 17 cases of Langerhans cell histiocytosis, 18 cases of fatigue fracture and 25 cases of bone tuberculosis in cases of bone marrow and surrounding soft tissue edema , Atypical osteomyelitis in 7 cases. In cases of abnormal soft tissue shadow, there were 7 cases of osteoblastoma, 1 case of chondroblastoma, 15 cases of Langerhans cell histiocytosis and 17 cases of bone tuberculosis. One case of osteosarcoma, 3 cases of Langerhans cell histiocytosis, 3 cases of fatigue fracture, 1 case of bone tuberculosis and 3 cases of atypical osteomyelitis. There were 7 cases of osteoblastoma, 3 cases of chondroblastoma, 4 cases of osteoid osteoma, 26 cases of Langerhans cell histiocytosis, 14 cases of fatigue fracture and 28 cases of bone tuberculosis Cases, atypical osteomyelitis in 4 cases. One case of osteoblastoma, two cases of chondroblastoma, two cases of Langerhans cell histiocytosis, and five cases of bone tuberculosis were found in cases of calcified ossification or remnant bone in soft tissue similar to tumorous bone. For benign and malignant coincidence rate and pathological coincidence rate, CT was slightly higher than MRI (P <0.05). The combination of three imaging methods could significantly improve the diagnostic accuracy (P <0.05). Conclusion Many benign bone lesions can be associated with invasive signs, to the diagnosis of difficulties. Combined application of three imaging methods comprehensive judgment, is to avoid misdiagnosed as the most simple and feasible method of malignant tumors.