骨与关节影像诊断.ppt

骨与关节影像诊断学（二）北京大学医院医学影像科骨关节结核继发性结核病，血行感染儿童、青少年多见脊柱及髋、膝关节好发临床经过缓慢骨关节结核长骨干骺端结核短管状骨骨干结核关节结核（滑膜型）脊柱结核骺和干骺端结核骨质疏松类圆形限局性骨质破坏中间可有碎屑死骨周围骨增生硬化不明显短管状骨骨干结核四肢短管状骨儿童多见，病变多发骨质破坏在骨内呈囊性改变骨膜增生使骨干增粗骨气鼓征Spina ventosa in a 22-year-old woman.Anteroposterior(a)and magnified(b)radiographs show extensive soft-tissue swelling with ballooning of the third metacarpal of the left hand.Findings of tuberculous arthritis are also seen in the adjacent joint(arrowheads)滑膜型关节结核青年人髋、膝大关节常见早期关节周围软组织肿胀，骨质疏松关节面非持重边缘部先有先有骨质破坏关节间隙狭窄Tuberculous arthritis in a 28-year-old man with pain.A-P(a)and magnified(b)radiographs show marginal osseous erosions of the femoral head(arrows)with relative preservation of the left hip joint space.There is also evidence of periarticular osteopenia.Tuberculous disease was confirmed with bone biopsy 脊柱结核椎体破坏椎间隙狭窄椎旁脓肿脊柱畸形Tuberculous spondylitis in a 17-year-old girl with low back pain.(a,b)A-P(a)and lateral(b)plain radiographs show loss of vertebral body height(arrowhead in a),sclerosis of the end plates,and anterior scalloping(arrowheads in b).(c)Sagittal T1 image shows focal decreased signal intensity(arrow).Sagittal T2-weighted(d)and Gd-T1-weighted(e)MR images show increased signal intensity(arrow).Tuberculous disease was confirmed with bone biopsy Tuberculous spondylitis with psoas abscess in a 21-year-old woman.(a)Midsagittal T1-MR images show loss of vertebral body height and decreased signal intensity at T4(arrows).(b)Coronal T2-weighted MR image of the upper dorsal spine shows bilateral paraspinal abscesses(arrows)with involvement of T4.(c,d)Axial T2-weighted(c)and parasagittal T2-weighted(d)MR images show a large,lobulated paraspinal mass with high signal intensity that extends to the posterior paravertebral region(arrows).The diagnosis was confirmed with biopsy of the abscess 骨肿瘤良性骨软骨瘤骨巨细胞瘤恶性原发：骨肉瘤继发：骨转移瘤骨软骨瘤起于长骨干骺端，邻近骺线向外突出的骨性肿块，皮质与正常骨相连有细长的蒂和宽基底软骨帽，可发生钙化骨骺闭合即停止生长Benign osteochondroma of the tibia in a 15-yrs boy with lesion growth.(a)Initial radiograph shows pathognomonic features of osteochondroma.The cortical(solid arrows)and medullary(*)continuity with the tibia was seen on radiographs.The cartilage cap is not mineralized and cannot be seen.(b-d)Axial MR images T1 obtained before(b)and after(c)Gd administration also reveal the cortical(arrowheads)and marrow(*)continuity with the underlying bone and yellow marrow in the lesion.The hyaline cartilage cap is 3 cm thick(curved arrows),shows mild peripheral and septal contrast material enhancement(straight arrows),and becomes very high signal intensity on the sagittal STIR MR image(d).Lateral radiograph obtained 2 years later shows lesion growth and mineralization that simulate malignant transformation but represent only growth in the immature patient.(f)Bone scan demonstrates marked increased uptake of radionuclide.(g)Photograph of the sagittally sectioned specimen correlates with the imaging appearance,revealing yellow marrow(*)and the thick hyaline cartilage cap(arrows).Foci of mineralization(x)are also seen,as noted previously in the MR images(b-d).骨巨细胞瘤青壮年（2040岁）多见，好发于股骨远端、胫骨近端、桡骨远端病变在骨端，偏心性，皂泡状溶骨破坏肿瘤呈膨胀性增大，骨皮质变薄无骨膜反应一般不破坏关节面Benign metastasizing GCT of the proximal tibia in a 30-year-old woman.(a)Anteroposterior radiograph shows an eccentric lytic metaepiphyseal lesion extending to subchondral bone with a narrow zone of transition(arrow).(b)Bone scintigram reveals increased radionuclide uptake peripherally and photopenia centrally(donut sign).(c)CT scan demonstrates mild expansion and sclerosis about the GCT(arrows)but no soft-tissue mass.On a coronal T2WI,the GCT demonstrates predominantly intermediate signal intensity with several high-signal-intensity foci(arrowheads)corresponding to secondary ABC regions.(e)Chest CT scan shows multiple pulmonary nodules in both lungs(arrowheads).(f)Photograph of the coronally sectioned whole mounted specimen(H-E stain)reveals a GCT extending to subchondral bone with ABC regions(white*)and solid areas(black*)成骨肉瘤青年男性（20岁以下）多见，好发于膝关节周围，长骨干骺端溶骨型：大片骨质破坏，骨膜反应呈“袖口征”，软组织肿块明显成骨型：大量瘤骨及骨膜新生骨多为混合型H骨转移瘤血行转移，多见于乳癌、肺癌、甲状腺癌、前列腺癌、肾癌等好发于脊柱、骨盆、颅骨等，且病变常为多发多为溶骨性破坏，可发生病理性骨折成骨转移多为前列腺癌等，在骨盆和腰椎松质骨内见到境界不清的斑片状致密影metastasis良、恶性骨肿瘤的鉴别生长情况局部骨变化骨膜增生周围软组织变化慢性骨关节病退行性骨关节病类风湿性关节炎强直性脊柱炎退行性骨关节病40岁以上男性多见，脊柱和髋、膝关节好发关节间隙狭窄关节面不规则骨质增生硬化，骨赘形成Case 1Case 2,T1&T2类风湿性关节炎多见于中年女性，累及近侧指间关节，多发软组织肿胀关节间隙变窄关节面边缘骨质虫蚀样破坏关节半脱位邻近骨骼骨质疏松RA in a 42-year-old woman.(a)Posteroanterior radiograph of the hands shows no evidence of erosion or joint space narrowing Coronal fat-suppressed Gd T1WI show marked periarticular enhancement(arrows)in multiple PIP and MCP joints 强直性脊柱炎见于成年男性病变从骶髂关节开始，早期表现为关节面凹凸不平，边缘模糊，以后关节间隙逐渐狭窄，以致完全消失，形成骨性强直病变向上发展，侵犯脊柱小关节椎旁韧带钙化，呈“竹节样”改变全身性骨病佝偻病长骨干骺端（尤其尺桡关节远端）表现典型干骺端加宽，呈杯口样凹陷先期钙化带模糊，出现毛刷样改变骨骺小，与干骺端距离加大普遍骨质密度减低其他骨关节疾病骨髓梗死Asymptomatic medial plica(type B)32-year-old,hit by a truck 10 months.A:3D-GE,low SI at cartilage;B:T1 SE,linear subcortical signal abnormality with deformity of cortex,typical impaction fraction;C:T2-FSE;D:Fat-suppressed T1 after intra-articular injection of GD,full thickness cartilage lossPCL完全撕裂CT在骨关节疾病中的应用