骨關(guān)節(jié)化膿性炎癥

骨結(jié)核與骨腫瘤中山大學(xué)孫逸仙紀(jì)念醫(yī)院放射科龔舒骨、關(guān)節(jié)感染性疾病化膿性骨髓炎化膿性關(guān)節(jié)炎骨關(guān)節(jié)結(jié)核：掌握脊柱結(jié)核關(guān)節(jié)結(jié)核化膿性骨髓炎、關(guān)節(jié)炎股骨急性化膿性骨髓炎—X線、MRIFS-T2WI右側(cè)脛骨急性化膿性骨髓炎—MRIFS-T2WIT1WICT+C

CT+C

股骨近段急性化膿性骨髓炎軟組織膿腫膿腔膿腫壁男性,41歲，慢性化膿性骨髓炎（顯示左股骨上段病變）同前病例，男性,41歲，慢性化膿性骨髓炎（顯示左股骨下段病變）同一病例的CT軸位（橫斷位）片同一病例的CT冠狀位重建右側(cè)尺骨慢性化膿性骨髓炎--X線36歲女性，左側(cè)下頜骨慢性化膿性骨髓炎同一病人:CT-VRTBrodie骨膿腫--慢性局限性骨膿腫

–X線SAGT1WISAGT2WISAGT1WI+CBrodie骨膿腫膿腫壁：MRI增強(qiáng)后可見環(huán)形強(qiáng)化環(huán)形骨質(zhì)硬化圓形透亮區(qū)CTCTBrodie骨膿腫TRAT1WITRAT2WITRAT1WI+C環(huán)形骨質(zhì)硬化透亮區(qū)男，13歲，左髖關(guān)節(jié)化膿性關(guān)節(jié)炎–X線正位蛙位男，13歲，左髖關(guān)節(jié)化膿性關(guān)節(jié)炎

–MRI（同上一病例）FS-T1WI+CFS-T2WIFS-T1WI骨、關(guān)節(jié)結(jié)核化膿性關(guān)節(jié)炎與關(guān)節(jié)結(jié)核的鑒別要點(diǎn)

鑒別要點(diǎn)化膿性關(guān)節(jié)炎關(guān)節(jié)結(jié)核臨床急（數(shù)天到數(shù)周）、發(fā)展快，發(fā)熱，紅、腫、熱、痛緩慢（數(shù)月到1年以上），關(guān)節(jié)疼痛和梭形腫脹關(guān)節(jié)改變軟骨較早破壞、關(guān)節(jié)間隙變窄軟骨較晚破壞骨質(zhì)破壞關(guān)節(jié)承重面關(guān)節(jié)非承重面骨質(zhì)、軟組織改變破壞與增生同時(shí)存在骨質(zhì)疏松僅見于早期，少有患肢軟組織萎縮破壞與骨質(zhì)疏松，少見骨質(zhì)增生，可有患肢軟組織萎縮疾病后遺骨性強(qiáng)直纖維強(qiáng)直胸椎結(jié)核伴冷膿腫男，15歲，胸椎多椎體結(jié)核（中心型）—MRIT1WI+CT1WIT1WIT2WI男，15歲，同上例，合并左橫突結(jié)核（附件型）—CT女，27歲，第7-9胸椎結(jié)核（前縱韌帶下型）—X線T2WIT1WIT1WI+CT2WI女，50歲，L1椎體結(jié)核（邊緣型）—MRI骨腫瘤與腫瘤樣病變掌握內(nèi)容:骨巨細(xì)胞瘤骨囊腫骨肉瘤骨轉(zhuǎn)移瘤鑒別診斷骨囊腫骨巨細(xì)胞瘤年齡青少年骺板愈合后癥狀無(wú)局部疼痛、腫脹、壓痛部位干骺端骨端生長(zhǎng)多位于中央、長(zhǎng)軸與骨骼長(zhǎng)軸一致偏心性生長(zhǎng)內(nèi)部囊性實(shí)性或囊實(shí)性骨壁光滑、無(wú)骨嵴多有骨嵴，似分隔或分房狀M,20歲，右下肢局部疼痛右側(cè)股骨外側(cè)髁骨巨細(xì)胞瘤CTofthesamepatientCorSagM,10-yearold左肩關(guān)節(jié)疼痛左側(cè)肱骨骨囊腫合并骨折右肱骨骨巨細(xì)胞瘤合并動(dòng)脈瘤樣骨囊腫—X線右側(cè)肱骨骨囊腫合并病理性骨折骨巨細(xì)胞瘤病理分級(jí)I級(jí)：良性II級(jí)：潛在惡性III級(jí)：惡性右側(cè)脛骨骨巨細(xì)胞瘤(gradeII)右側(cè)脛骨骨巨細(xì)胞瘤(gradeIII)男，31歲，左肱骨骨巨細(xì)胞瘤（Grade3）—X線、MRIT1WI+CT1WI男，31歲，左肱骨高級(jí)別骨巨細(xì)胞瘤—MRIT2WI男，27歲，左肱骨上端骨巨細(xì)胞瘤合并病理骨折—MRIT1WI+CT1WIFS-T2WI男，7歲，左肱骨中上段骨囊腫--MRIFS-T2WIT1WI+C第二趾近節(jié)趾骨骨巨細(xì)胞瘤—X線M,14歲.發(fā)現(xiàn)右肩腫塊來(lái)診CTofthesamepatientCORSofttissuewindowBonewindowSAGSofttissuewindowBonewindowTRABonewindowMRIofthesamepatientT2-SPIRCORT1-WATS+CCORT1-WATS+CSAGT1-WATSTRAT1-WATS+CTRA影像所見：右側(cè)肱骨上段可見多發(fā)不規(guī)則片狀骨質(zhì)破壞區(qū)，并見片狀、云絮狀高密度瘤骨形成，肱骨頭處部分皮質(zhì)中斷，骨皮質(zhì)外可見明顯層狀骨膜增生，并見Codman’三角形成。周圍軟組織腫脹，期內(nèi)亦可見片絮狀高密度瘤骨形成。余右肩關(guān)節(jié)骨質(zhì)尚完整，未見明確骨質(zhì)破壞，右肩關(guān)節(jié)間隙未見增寬或狹窄，其內(nèi)未見異常密度影。影像診斷：右側(cè)肱骨上段骨肉瘤（混合型）。右股骨骨肉瘤（混合型）—X線股骨骨肉瘤（混合型）—X線股骨骨肉瘤—MRIT1WIT1WI股骨骨肉瘤—MRIFS-T1WI+C女，20歲，右下頜骨骨肉瘤（成骨型）—CT鑒別診斷骨肉瘤化膿性骨髓炎急性發(fā)作史無(wú)有病變范圍局限有向全骨蔓延趨勢(shì)瘤骨有無(wú)骨膜反應(yīng)常被腫瘤破壞不常被破壞骨質(zhì)增生輕與骨質(zhì)破壞同步顱骨多發(fā)骨轉(zhuǎn)移瘤男，30歲，轉(zhuǎn)移瘤（陰莖Ca）--X線女，48歲，轉(zhuǎn)移瘤（乳Ca）--X線脊柱成骨性轉(zhuǎn)移瘤(L4)M,53yrMetastasisofT10spineT1W-SAGT2W-SPIRSAGT2W-TRAT1W-TRA+CMRIofthesamepatient肺癌溶骨性骨轉(zhuǎn)移X-rayfindametastasisinT12(the12ththoracicvertebra)Compressfracture肺癌溶骨性骨轉(zhuǎn)移CT發(fā)現(xiàn)更多病變（多個(gè)椎體受累）Caseanalysis

F,16-yearsoldpresentwithpaininherleftankleformonthsAPradiographoftheankle:Normalornot?case1CaseanalysisNopositivefindinginAPradiographT2W-SPIRT1W-SPIR+cCaseanalysiscase1ThesamepatientCoronalT2-weightedfatsuppressedMRIshowshighsignalinthedistalendofthefibulawithsoft-tissueedemaaround.CoronalT1-weightedfat-suppressedMRIfollowinggadoliniuminjectionshowsenhancementinthelesion.case1AfterantibiotictherapyforafewweeksCaseanalysisCoronalT2-weightedfatsuppressedMRIshowsmildmarrowedemainthedistalendofthefibula

T2W-SPIRT1WX-rayascleroticriminthedistalendofthefibulaWhat’syouranswerforcase1?

CaseanalysisDiscussionofthiscaseAcuteandshorthistoryEarlyX-raymaybenormalThemostsensitivemethodstodetectanacuteosteomyelitisisMRInosoft-tissuemassAfterantibiotictherapy,marrowedemawouldbelightenAcuteosteomyelitis

Brodieabscessintherightintertrochantericcrest:presentsasaroundtoovoidradiolucencywithathickscleroticrim.CaseanalysisCase2Male,12-yearsold,presentwithpain

intherightthighformorethan1yearScleroticrimCaseanalysisCase2MRIofthesamepatientT1WISAGT2WISPIRSAGT2WISPIR+CSAGT2WISPIR+CTRA

*aprimarychronicpyogenicinfection,usuallyproducingaroundabscesscavity1-4cmindiameterCase2:BrodieabscessCaseanalysis

generallyappearsasadefectwithoutcontrastenhancement

However,thedefectcanenhanceiftheabscesscavityisfilledwithinfectiousgranulationtissueratherthanpus(rare)*ThelesionhashighsignalintensityonSTIRandT2-weightedimages*Thescleroticrimisoflowsignalintensity,butmayfaintlyenhancewithcontrastCaseanalysisWhat’syourdiagnosisforthiscase?Whatcharacteristicsigncanyoufindtosupportyourdiagnosis?Case3sequestrumChronicosteomyelitisNarrowingandclosingofthemedullarycavitySequestrum：

anecroticosseousfragmentcompletelysurroundedbytheinfectiousprocess（granulationtissue/pus）

(=radiolucentrim)Discussionofcase3：X-rayfeaturesofchronicosteomyelitis:*

irregularsclerosiswithlossofthetrabecularstructure*

inadditiontoosteolyticdestructionandsolidperiostealreactions*SequestrationisalsopossibleCaseanalysisCase4Female,78-yearold,prestentwithPaininherbackCaseanalysisOsteolyticdestructionwithoutscleroticreactionoftheL3~4CTofthesamepatientCaseanalysisCase4OsteolyticdestructionwithoutscleroticreactionPsoasabscesssequestrumMRIofthesamepatientCaseanalysisCase4PsoasabscessWithperipheralenhancementT2WISAGT1WISAGT1WI+CSAGT2WIT1WI+Cwhat’syouranswerforthiscase?CaseanalysisTuberculosisinL3~4CaseanalysisCase5APandlateralradiographsofthekneeIvory-liketumorboneintheproximalendofthetibia

CaseanalysisCase5

CTofthesamepatientTRACORSAGI