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中华老年骨科与康复电子杂志 ›› 2020, Vol. 06 ›› Issue (03) : 165 -170. doi: 10.3877/cma.j.issn.2096-0263.2020.03.008

所属专题: 文献

医学影像

骨促结缔组织增生性纤维瘤的影像诊断与鉴别诊断
钟志伟1, 马洁琳2, 王勇3, 郭哲1, 陈伟4, 吴文娟1,()   
  1. 1. 050051 石家庄,河北医科大学第三医院放射科
    2. 050051 石家庄,河北医科大学第三医院放疗科
    3. 253800 河北省故城县医院放射科
    4. 050051 石家庄,河北医科大学第三医院骨科
  • 收稿日期:2019-12-25 出版日期:2020-06-05
  • 通信作者: 吴文娟
  • 基金资助:
    2017河北省科技厅课题(17277779D)

Imaging diagnosis and differential diagnosis of desmoplastic fibroma of bone

Zhiwei Zhong1, Jielin Ma2, Yong Wang3, Zhe Guo1, Wei Chen4, Wenjuan Wu1,()   

  1. 1. Department of Radiology, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
    2. Department of Radiotherapy, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
    3. Department of Radiology, Hospital of Gucheng County, Gucheng 253800, China
    4. Institute of Orthopaedics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
  • Received:2019-12-25 Published:2020-06-05
  • Corresponding author: Wenjuan Wu
引用本文:

钟志伟, 马洁琳, 王勇, 郭哲, 陈伟, 吴文娟. 骨促结缔组织增生性纤维瘤的影像诊断与鉴别诊断[J]. 中华老年骨科与康复电子杂志, 2020, 06(03): 165-170.

Zhiwei Zhong, Jielin Ma, Yong Wang, Zhe Guo, Wei Chen, Wenjuan Wu. Imaging diagnosis and differential diagnosis of desmoplastic fibroma of bone[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2020, 06(03): 165-170.

目的

分析骨促结缔组织增生性纤维瘤的影像学表现,总结骨促结缔组织增生性纤维瘤的影像学诊断特点和鉴别诊断要点。

方法

回顾性分析2002年1月至2019年10月经病理证实的13例骨促结缔组织增生性纤维瘤的X线、CT和MRI,分析影像学表现包括:发病部位、骨质破坏情况、病变内的骨质密度、病变区的MR信号特点及周围侵袭性特点。

结果

13例骨促结缔组织增生性纤维瘤患者中,男性7例,女性6例,年龄为2~52岁,中位年龄27岁。本组13例的发病部位是长骨8例,髂骨3例,椎体及跟骨各1例。长骨常见于干骺端,可累及骨干及骨端。丝瓜瓤型6例,溶骨型3例,混合型3例,骨旁型1例。病变区内的CT值30~60 Hu(6例CT值大于45 Hu)。具有MRI检查的8例患者中5例表现为T1WI呈不均匀等或低信号,T2WI呈不均匀等或高信号,其内可见T1WI、T2WI均为低信号区域;3例病变区呈均匀长T1长T2信号。13例DFB中9例病变周围可见软组织肿块。

结论

骨促结缔组织增生性纤维瘤具有侵袭性,以丝瓜瓤型多见,病变区存在T1WI、T2WI均为低信号,有助于其诊断及鉴别诊断。

Objective

To analyze the imaging features of desmoplastic fibroma of bone (DFB) and summarize its imaging diagnosis characters and differential diagnosis.

Methods

Retrospectively analyzed the X-ray, CT and MRI of 13 cases of DFB were confirmed by pathology from January 2002 to October 2019, and analyzed the imaging findings, including the location of the tumor, the destruction of the bone, and the bone of density in the lesion, characteristics of magnetic resonance signals and range of encroachment.

Results

There were 7 males and 6 females, aged from 2-52 years old, more common in adolescents under 30 years old. 8 cases occurred at long bone, 3 cases occurred at sacrum and 1 case of vertebra and calcaneus. DFB is common in the metaphysis of long bones, and it can involve the diaphysis and epiphysis. There were 6 cases of loofah cyst type, 3 cases of osteolytic type, 3 cases of mixed type, and 1 case of parabone type. CT value is 30-60 Hu in the lesion area (6 cases CT value>45 Hu). 5 cases showed low mixed signals on T1WI and high mixed signals on T2WI, and showed low signals on T1WI and T2WI in the region. 3 cases showed Homogeneous low signal on T1WI and high signal on T2WI. 9 patients had soft tissue lumps.

Conclusions

DFB is a rare tumor with strong local aggressiveness, the loofah cyst type was more common in DFB, the low signals on T1WI and T2WI in the lesion, which are helpful for diagnosis and differentiate diagnosis of the disease.

图1~7 男,14岁,股骨促结缔组织增生性纤维瘤。图1 X线片示:右股骨中段呈膨胀性、中心性破坏,皮质变薄及部分中断,周围可见较粗大的"根须状"骨小梁或骨嵴。图2~3 CT冠状位重组及三维重建:股骨中段呈膨胀性、中心性破坏,其内CT值46Hu,周围可见较粗大的"根须状"骨小梁或骨嵴,未见明显骨膜反应,皮质变薄及部分中断,侵犯周围软组织;图4 MR表现:股骨中段T1WI呈不均匀等或低信号;图5 T2WI呈不均匀高信号、其内可见散在的索条及斑片状低信号区;图6 低信号区未见明显强化,周围软组织受侵;图7 病理(HEx100):梭形的成纤维细胞及胶原纤维呈束状排列,细胞形态、大小规则,未见核分裂
图8~13 男,14岁,左髂骨促结缔组织增生性纤维瘤。图8 X线片示:左侧髂骨呈地图样骨质破坏,皮质变薄,周围可见残存骨嵴和"根须状"骨小梁;图9~10 CT轴位及冠状位重组:左侧髂骨呈膨胀性性骨质破坏,其内密度不均匀,较高密度区CT值为56Hu、局部可见含脂低密度区,病变周围存在骨嵴及少量"根须状"骨小梁,皮质变薄及部分中断,侵犯周围软组织;图11 MR表现:左侧髂骨T1WI呈不均匀等或低信号;图12 T2WI呈不均匀高信号、其内可见较大范围低信号区,周围软组织受侵;图13 病理(HEx100):梭形细胞增生,细胞较少,胶原纤维呈束状或波浪状排列,肿瘤呈浸润性生长
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