骨骼肌肉系统疾病液液平面征PPT课件.ppt

骨骼肌肉系统疾病 液液平面征 MusculoskeletalLesionsWithFluid FluidLevel DepartmentofRadiologythe2ndaffiliatedhospitalofSunyat senuniversity 1 一 概述 overview 2 9 11 2 的骨病变中可出现液 液平面 PrevalenceofFFLinbonetumorsis2 9 11 2 T2WI上观察佳 MostconspicuousonT2WI 常与出血及肿瘤坏死有关 Relatedtopriorhemorrhageortumornecrosis CT上 各层CT值的不同形成了FFL ThedifferenceinthedensityoftheselayerscanbeobservedonCTimaging MRI上 各层信号上的差异形成了FFL ThedifferenceinthesignalcharacteristicsoftheselayersallowforvisualizationoftheFFLonMRI 2 单发FFL singleFFL 8 多发FFLs MultipleFFLs 75 3 1 3 2 3 entire 1 3 2 3 4 5 二 病变的种类 typiesofthelesion 一 骨病变 动脉瘤样骨囊肿AneurysmalBoneCyst ABC单纯性骨囊肿SimpleBoneCyst骨纤维异常增殖症FibrousDysplasia骨内脂肪瘤IntraosseousLipoma软骨母细胞瘤Chondroblastoma毛细血管扩张型骨肉瘤TelangiectaticOsteosarcoma 6 二 软组织病变血肿Hematoma肌间血管瘤IntramuscularHemangioma动静脉畸形ArteriovenousMalformation关节周围钙质沉着PeriarticularCalcinosis软组织平滑肌瘤SoftTissueLeiomyoma肉瘤Sarcoma 二 病变的种类 typiesofthelesion 7 动脉瘤样骨囊肿 aneurysmalbonecyst ABC 薄壁分隔 血性液体充盈多房房腔为特点的膨胀性骨病变 ABCisanexpansilelesioncontainingmixedmultiplethinwalled bloodfilledcysticcavities 创伤是引发该病的原因之一 Traumahasbeenindicatedasacause 常伴发于其他骨病变 Oftenarisessecondarytoapreexistinglesion 好发年龄在5 20岁 长管状骨的干骺端多见 也可见于脊柱附件 Mostcommonlyoccurwithinthemetaphysisoflongtubularbones buttheyarealsofoundwithintheposteriorelementsofthespine 8 Imagingmanifestation 偏心性膨胀性骨质破坏 常伴骨性分隔 甚者可呈气球样 病变内缘常完整 Eccentric osteolyticlesion oftenwithseptations thecorticalsurfaceexpandedorballooned andtheinnermarginiswelldefined MRI上 ABC常呈薄而完整的低信号边缘 病灶内信号不均匀 房腔间信号可存在显著差异 Athin well definedrimoflow signalintensityabouttheABCiscommon Thereisinhomogeneityofthesignalintensity withindividuallobuleshavingmarkedlydifferentsignalcharacteristics 85 可见液 液平面 常为多个液平 是ABC发展到中期或晚期阶段的典型表现 FFLscanbeseenin85 patients andaretypicalofthemidorlatephaseofdevelopmentoftheABC 9 16 的ABC可发生于骨表面 分为骨膜下型 骨皮质型及混合型 SixteenpercentofABCarisefromsurfaceofbones includingsubperiosteal cortical mixed 骨膜下型ABC常具有侵袭性 可致周围软组织水肿 易误诊为毛细血管扩张型骨肉瘤 ABCsinsubperiosteallocationcandemonstrateaggressiveradiographicappearanceandedemaofadjacentsofttissuesmimickingtelangiectaticosteosarcoma Imagingmanifestation 10 Aneurysmalbonecyst AxialT2WIshowslargemultilocularcysticlesionwithmultiplefluid fluidlevels arrow occupyingmorethanonehalfofthelesion Theinferiorlayerisslightlyhyperintensecomparedtomuscle andthesuperiorlayerishyperintense 11 ABCsecondarytogiantcelltumorsoftheSacrum 12 ABCsecondarytotheameloblastomaofjaws 13 21yearsoldmanwithcorticalaneurismalbonecystofthetibia 14 单纯性骨囊肿 SimpleBoneCyst 含液体性的病变 可继发于淋巴或静脉回流障碍 Fluid containinglesionthatmayarisesecondarytolymphaticorvenousobstruction 常发生于长管骨的干骺端并向骨干生长 Usuallyarisesinthemetaphysisoflongbonesadjacenttothephysis 80 的病变发生于20岁以下 80 ofthelesionsoccurunder20years 发生于20岁以上者 可见于髂骨和跟骨 Overtheageof20 theymaylocatedattheiliacboneandthecalcaneus 极少出现临床症状 除非发生病理性骨折 rarelysymptomaticunlesswithapathologicfracture 15 中央性骨透亮区 伴骨皮质变薄和中度骨膨胀改变 Centrallylocatedradiolucentlesionwithcorticalthinningandmildosseousexpansion20 出现 骨片陷落征 Fallenfragment signmaybeseenin20 ofcases液 液平面的出现可能与病理性骨折有关 FFLarisedprobablyduetothepathologicfracture Imagingmanifestation 16 Nine year oldmalewithSBCofproximalhumerus 17 SimplebonecystAxialTSET2WIshowsacysticaspectofthelesionwithasinglefluid fluidlevel arrow Thedependentfluidlayerisslightlyhyperintensecomparedtomuscle and relativetotheinferiorlayer thesuperiorlayerishyperintense suggestingserousfluid 18 骨纤维异常增殖症 FibrousDysplasia 为原始间叶组织发育异常 FDisadevelopmentalanomalyofboneformingmesenchyme 多数病例发生于2 30岁 Mostlybeseenbetweentheagesof2and30 70 80 为单发 无临床症状 70 80 ofcasesaremonostoticandasymptomatic 20 30 为多发型 多见于10岁前 常发生跛行 疼痛 骨折或畸形 50 以上可见皮肤牛奶咖啡斑 且有一侧身体受累更广泛的倾向 20 30 arepolyostotic andpresentbeforetheageof10 oftenwithalimp pain fracture ordeformity Cafe au laitspotsareseeninover50 ofpatients Thereisapropensitytoinvolveonesideofthebodymoreextensively 19 骨纤维异常增殖症 FibrousDysplasia 2 3 的多发型FD伴有内分泌疾病 2 3 ofpatientswithpolyostoticdiseaseassociatedendocrinopathy Albright综合征 伴女性青春期性早熟和皮肤色素沉着 McCuneAlbrightsyndromeinvolvesprecociouspubertyinfemalesandcutaneouspigmentationinadditiontothebonelesions Mazabraud综合征 合并软组织粘液瘤 Mazabraudsyndromeinvolvesasofttissuemyxomainassociationwiththeosseouslesions 20 Imagingmanifestation 具有网状新生骨的透亮区 界限清楚并可见硬化边 Radiolucentlesionswithwovenbone usuallywelldefinedandmayhaveascleroticrind常发生骨骼畸形 并伴发骨折 骨弯曲和生长障碍 Skeletaldeformityisoftennoted withfractures bowing andgrowthdisturbance 可恶变为骨肉瘤和纤维肉瘤 Malignanttransformationcanbeseenwithosteosarcomaandfibrosarcomabeingthemostcommon 囊性FD可出现液 液平面 FFLhasbeenreportedincysticfibrousdysplasia 21 Fibrousdysplasia SagittalT2WIshowsinhomogeneousandoveralllowsignalintensityofthebonemarrow Afluid fluidlevel arrow inalarge singlecavitycanbeseen Theinferiorfluidlayerisslightlyhyperintensecomparedtomuscle and thesuperiorlayerishyperintense 22 twenty six year oldmanwithpolyostoticcysticfibrousdysplasia 23 骨内脂肪瘤 IntraosseousLipoma 罕见 多见于30 60岁 Berare usuallyfoundin30 60yearsofage 好发于腓骨 股骨 胫骨的干骺端和跟骨 Themostcommonsitesarethemetaphysisofthefibula femur tibia andcalcaneus 24 Imagingmanifestation 具有硬化边的境界清楚的骨破坏区 可呈轻度膨胀改变 无骨皮质破坏或骨膜反应 Osteolyticlesionsurroundedbyawell definedscleroticborderwithslightlyexpansileandwithoutcorticaldestructionorperiostealreaction CT及MRI上呈脂肪密度 信号 Fatdensity signalcharacteristics 液 液平面很罕见 FFLisrarelyseen 25 28岁男性 跟骨骨内脂肪瘤 26 软骨母细胞瘤 Chondroblastomas 少见的良性实质性的软骨来源肿瘤 Uncommon solitary andbenigncartilaginousneoplasms 常见于5 25岁间 男女发病率之比为2 1 Mostlyoccurbetweentheagesof5and25 withamaletofemalepredominanceof2 1 好发于长管骨的骨骺或隆突处 可扩展至干骺端 Ariseintheepiphysisorapophysisofalongtubularbone andcanextendintothemetaphysis 27 Imagingmanifestation 常呈地图样偏心性骨质破坏区 但少有膨胀性改变 Geographiclyticlesion usuallyeccentric andrarelyexpansile 30 50 的病例可见软骨基质钙化 可见骨膜反应 Thecalcifiedchondroidmatrixisnotedin30 50 Aperiostealreactionmayalsobeseen MRI上 病变T1WI呈低信号 T2WI信号复杂 OnMRI oftenlowsignalonT1WI withvariableT2WIsignalcharacteristics 28 足骨软骨母细胞瘤 chondroblastomasofthefoot 13 可见于足骨 13 ofchondroblastomasarefoundinthefoot 平均发病年龄为26岁 Meanageis26years 跟骨者均发生于跟骨的跟距关节面且邻近跟骨后部骨皮质处 Mostcommonlyfoundinposteriorsubchondralareasoftalusandcalcaneusandincalcanealapophysis 可见硬化缘 偶尔还可见病灶内钙化和分隔 Scleroticmarginwaspresent occasionallycalcificationsandseptationswereseen 29 twenty five year oldmanwithchondroblastomaofcalcaneus 30 毛细血管扩张型骨肉瘤 TelangiectaticOsteosarcoma 占骨肉瘤的2 5 12 Represents2 5 12 ofallosteosarcomas 膨胀性破坏性骨肿瘤 大多由含坏死组织和出血的囊腔构成 Anexpansile destructivetumor whichislargelycomposedofcysticcavitiescontainingnecrosisandhemorrhage 常见于干骺端 可扩展至骨骺 并常合并病理性骨折 Mostlyoriginfromthemetaphysis monlypresentwithpathologicfractures 32 Imagingmanifestation 地图样骨破坏区 伴有较宽的移行带 并膨胀变形及周围软组织肿块 Geographicbonedestructionwithawidezoneoftransition expansileremodelingandsofttissuemass 病灶内见多个相互分隔的膨胀囊腔 囊壁上可见壁结节 Multipledilatedcavitiesareseparatedbyseptations andnodularitycanbeseenwithintheseseptation T2WI呈显著高信号 T1WI呈中等信号 74 的病例可见到液 液平面 OnMRI signalintensityisredominatelyhighonT2WI andintermediateonT1WI FFLsarenotedin74 ofcases 33 Twenty one year oldmanwithtelangiectaticosteosarcomaofdistalfemur 34 telangiectaticosteosarcoma APradiographshowsaggressivebonedestructionwithapathologicalfracture MRIconfirmalarge extraosseousmass AxialT2WIshowmostofthemass estimatedtobe 2 3 tobeoccupiedbyFFLs 35 Others 液 液平面也以个例报道见于骨巨细胞瘤 骨腱鞘囊肿 骨髓炎 骨转移瘤和多发骨髓瘤 FFLshavealsobeenreportedingiantcelltumor intraosseousganglia osteomyelitis metastasis andmultiplemyelomaascasereports 36 血肿Hematoma肌间血管瘤IntramuscularHemangioma动静脉畸形ArteriovenousMalformation关节周围钙质沉着PeriarticularCalcinosis软组织平滑肌瘤SoftTissueLeiomyoma肉瘤Sarcoma 软组织病变 SoftTissueLesions 37 血肿 Hematoma 影像学表现依赖于其内部成分及演变进程 Imagingcharacteristicsdependontheinternalcomponentanddevelopmentofthelesion 超急性期 T1WI和T2WI上均呈高信号 Inthehyperacutesetting thelesionhavehighT1andT2signalintensity 亚急性期及以后 病变内可见到 同心环征 由外周高信号及中心低信号区所构成 Inthesubacutephaseandbeyond mayseethe concentricringsign whichhashigh signalintensitywitheventualcentralregionsofdecreasedsignalintensity 38 Fifty eight year oldwomanwithhematoma 39 肌间血管瘤 IntramuscularHemangioma 最常见的软组织肿瘤之一 Oneofthemostcommonsofttissuetumors 属于良性血管性病变 可含有非血管成分 如脂肪 纤维和粘液样组织 平滑肌 血栓甚至骨组织 Benignvascularlesions whichmaycontainnonvascularelementssuchasfat fibrousandmyxoidtissue smoothmuscle thrombus andevenbone 30 的病例可见静脉石 最多见于海绵状血管瘤 30 containphleboliths mostfrequentlyinthecavernoustype 40 Imagingmanifestation 分叶状 分隔状 增强后显著强化 Lesionsarelobulated septated withmarkedenhancementonMRI T2WI上见病灶内的低信号纤维分隔及蜿蜒走行的血管影 OnT2WI low signalfibrousseptaandhigh signalserpentinevascularchannelsareseen 中央低信号影为横切的间隔 玻璃样变或栓塞血管 平滑肌 血管流空或钙化 Centrallow intensitydotsmayrepresentseptaimagedincross section hyalinizedorthrombosedvascularchannels smoothmusclecomponents fastflowwithinbloodvessels orcalcification 41 Thirty two year oldwomanwithintramuscularhemangiomaofthigh 42 Intramuscularcavernoushemangioma AxialT2WIshowingMultilocularlesion hyperintensetomuscle Multiplefluid fluidlevels arrows occupyingmorethanonehalfofthelesioncanbeseen 43 动静脉畸形 ArteriovenousMalformation 可为先天性 出现于生后几年内 也可以继发于创伤 Lesionsmaybedevelopmentalinorigin appearinginthefirstfewyearsoflife ortheymayoccurafteraninjury MRI表现包括肌肉萎缩 皮下脂肪浸润 以及静脉石或血管流空而形成的灶性低信号 MRfeaturesincludemuscleatrophy subcutaneousfattyprominence andfocioflow signalintensity whichmaybeindicativeofphlebolithsorflowvoideffects 20液 液平面较为罕见 FFLisrarelyseen 44 Thirty six year oldwomanwitharteriovenousmalformationofthigh 45 关节周围钙质沉着 PeriarticularCalcinosis 多见于血液透析病人 Maybeseeninpatientsonhemodialysis 髋关节及臀部肌肉组织是好发部位 Thehipsandglutealmusculaturearecommonsitesofinvolvement液 液平面出现是液体悬置所致 FFLseenwithinthecalciumdepositsareduetoaqueoussuspensions 可伴有软骨下 骨膜下或韧带下骨吸收 骨质疏松和棕色瘤 Additionalradiographicfindingsincludesubchondral subperiosteal orsubligamentousboneresorption osteoporosis andBrowntumor 46 64year oldwomanonhemodialysisforrenalfailurewithpara articularcalcinosis 47 软组织平滑肌瘤 SoftTissueLeiomyoma 发生于胃肠道和泌尿生殖系统之外的软组织平滑肌瘤很罕见 Leiomyomasfoundoutsidethegastrointestinalandgenitourinarysystemsarerare 可单发也可多发 可发生坏死和钙化 Maybesolitaryormultipleandmayhavenecroticandcalcificcomponents 液 液平面较为罕见 FFLisrarelyseen 48 Twenty seven year oldmanwithsofttissueleiomyoma 49 滑膜肉瘤 SynovialSarcoma 好发于20 40岁患者四肢大关节附近 Themostcommonlocationisclosetothelargejointof20 40yearsofage 常形成囊变区及多房状 Featuresincludecystformationandmultilocularity 常见临床症状有疼痛 肿胀 Symptomsareoftenpainand orswelling 50 Imagingmanifestation 大关节 肌腱 滑囊旁非均匀分房状肿块 可侵犯关节及骨质 Inhomogeneousseptatemassclosetoajoint atendonorabursa Boneandjointinvasioncanbepresent 1 3病灶内部尤其是边缘部位可见多发小钙化或骨化影 Themostcharacteristicfindingisthemultiplefocalcalcificationsorossificationstypicallyintheperipheryofthelesionin1 3patients MRI上信号不均匀 T2WI上同时呈低 中 高信号及T1WI上斑点状高信号可提示诊断 TriplesignalpatternonT2WItogetherwiththesmallhighsignalfocionT1WIissuggestiveforsynovialsarcoma 51 synovialsarcoma AxialT2WIwithfatsuppression Largerelative