骨與關(guān)節(jié)影像診斷學

（二）北京大學第一醫(yī)院醫(yī)學影像科王繼琛骨關(guān)節(jié)結(jié)核繼發(fā)性結(jié)核病，血行感染兒童、青少年多見脊柱及髖、膝關(guān)節(jié)好發(fā)臨床經(jīng)過緩慢骨關(guān)節(jié)結(jié)核長骨干骺端結(jié)核短管狀骨骨干結(jié)核關(guān)節(jié)結(jié)核（滑膜型）脊柱結(jié)核骺和干骺端結(jié)核骨質(zhì)疏松類圓形限局性骨質(zhì)破壞中間可有碎屑死骨周圍骨增生硬化不明顯短管狀骨骨干結(jié)核四肢短管狀骨兒童多見，病變多發(fā)骨質(zhì)破壞在骨內(nèi)呈囊性改變骨膜增生使骨干增粗骨氣鼓征Spina

ventosaina22-year-oldwoman.Anteroposterior

(a)andmagnified(b)radiographsshowextensivesoft-tissueswellingwithballooningofthethirdmetacarpalofthelefthand.Findingsoftuberculousarthritisarealsoseenintheadjacentjoint(arrowheads)滑膜型關(guān)節(jié)結(jié)核青年人髖、膝大關(guān)節(jié)常見早期關(guān)節(jié)周圍軟組織腫脹，骨質(zhì)疏松關(guān)節(jié)面非持重邊緣部先有先有骨質(zhì)破壞關(guān)節(jié)間隙狹窄Tuberculousarthritisina28-year-oldmanwithpain.A-P(a)andmagnified(b)radiographsshowmarginalosseouserosionsofthefemoralhead(arrows)withrelativepreservationofthelefthipjointspace.Thereisalsoevidenceofperiarticular

osteopenia.Tuberculousdiseasewasconfirmedwithbonebiopsy脊柱結(jié)核椎體破壞椎間隙狹窄椎旁膿腫脊柱畸形Tuberculous

spondylitisina17-year-oldgirlwithlowbackpain.(a,b)A-P(a)andlateral(b)plainradiographsshowlossofvertebralbodyheight(arrowheadina),sclerosisoftheendplates,andanteriorscalloping(arrowheadsinb).(c)

SagittalT1imageshowsfocaldecreasedsignalintensity(arrow).SagittalT2-weighted(d)andGd-T1-weighted(e)MRimagesshowincreasedsignalintensity(arrow).TuberculousdiseasewasconfirmedwithbonebiopsyTuberculous

spondylitiswithpsoasabscessina21-year-oldwoman.(a)

MidsagittalT1-MRimagesshowlossofvertebralbodyheightanddecreasedsignalintensityatT4(arrows).(b)CoronalT2-weightedMRimageoftheupperdorsalspineshowsbilateralparaspinalabscesses(arrows)withinvolvementofT4.(c,d)AxialT2-weighted(c)andparasagittalT2-weighted(d)MRimagesshowalarge,lobulated

paraspinalmasswithhighsignalintensitythatextendstotheposteriorparavertebralregion(arrows).Thediagnosiswasconfirmedwithbiopsyoftheabscess骨腫瘤良性骨軟骨瘤骨巨細胞瘤惡性原發(fā)：骨肉瘤繼發(fā)：骨轉(zhuǎn)移瘤骨軟骨瘤起于長骨干骺端，鄰近骺線向外突出的骨性腫塊，皮質(zhì)與正常骨相連有細長的蒂和寬基底軟骨帽，可發(fā)生鈣化骨骺閉合即停止生長Benignosteochondromaofthetibiaina15-yrsboywithlesiongrowth.(a)Initialradiographshowspathognomonicfeaturesofosteochondroma.Thecortical(solidarrows)andmedullary(*)continuitywiththetibiawasseenonradiographs.Thecartilagecapisnotmineralizedandcannotbeseen.(b-d)AxialMRimagesT1obtainedbefore(b)andafter(c)

Gdadministrationalsorevealthecortical(arrowheads)andmarrow(*)continuitywiththeunderlyingboneandyellowmarrowinthelesion.Thehyalinecartilagecapis3cmthick(curvedarrows),showsmildperipheralandseptalcontrastmaterialenhancement(straightarrows),andbecomesveryhighsignalintensityonthesagittalSTIRMRimage(d).骨巨細胞瘤青壯年（20~40歲）多見，好發(fā)于股骨遠端、脛骨近端、橈骨遠端病變在骨端，偏心性，皂泡狀溶骨破壞腫瘤呈膨脹性增大，骨皮質(zhì)變薄無骨膜反應(yīng)一般不破壞關(guān)節(jié)面成骨肉瘤青年男性（20歲以下）多見，好發(fā)于膝關(guān)節(jié)周圍，長骨干骺端溶骨型：大片骨質(zhì)破壞，骨膜反應(yīng)呈“袖口征”，軟組織腫塊明顯成骨型：大量瘤骨及骨膜新生骨多為混合型H骨轉(zhuǎn)移瘤血行轉(zhuǎn)移，多見于乳癌、肺癌、甲狀腺癌、前列腺癌、腎癌等好發(fā)于脊柱、骨盆、顱骨等，且病變常為多發(fā)多為溶骨性破壞，可發(fā)生病理性骨折成骨轉(zhuǎn)移多為前列腺癌等，在骨盆和腰椎松質(zhì)骨內(nèi)見到境界不清的斑片狀致密影metastasis良、惡性骨腫瘤的鑒別生長情況局部骨變化骨膜增生周圍軟組織變化慢性骨關(guān)節(jié)病退行性骨關(guān)節(jié)病類風濕性關(guān)節(jié)炎強直性脊柱炎退行性骨關(guān)節(jié)病40歲以上男性多見，脊柱和髖、膝關(guān)節(jié)好發(fā)關(guān)節(jié)間隙狹窄關(guān)節(jié)面不規(guī)則骨質(zhì)增生硬化，骨贅形成Case1Case2,T1&T2類風濕性關(guān)節(jié)炎多見于中年女性，累及近側(cè)指間關(guān)節(jié)，多發(fā)軟組織腫脹關(guān)節(jié)間隙變窄關(guān)節(jié)面邊緣骨質(zhì)蟲蝕樣破壞關(guān)節(jié)半脫位鄰近骨骼骨質(zhì)疏松RAina42-year-oldwoman.(a)PosteroanteriorradiographofthehandsshowsnoevidenceoferosionorjointspacenarrowingCoronalfat-suppressedGdT1WIshowmarkedperiarticularenhancement(arrows)inmultiplePIPandMCPjoints強直性脊柱炎見于成年男性病變從骶髂關(guān)節(jié)開始，早期表現(xiàn)為關(guān)節(jié)面凹凸不平，邊緣模糊，以后關(guān)節(jié)間隙逐漸狹窄，以致完全消失，形成骨性強直病變向上發(fā)展，侵犯脊柱小關(guān)節(jié)椎旁韌帶鈣化，呈“竹節(jié)樣”改變?nèi)硇怨遣∝E病長骨干骺端（尤其尺橈關(guān)節(jié)遠端）表現(xiàn)典型干骺端加寬，呈杯口樣凹陷先期鈣化帶模糊，出現(xiàn)毛刷樣改變骨骺小，與干骺端距離加大普遍骨質(zhì)密度減低其他骨關(guān)節(jié)疾病骨髓梗死Asymptomaticmedialplica(typeB)

32-year-old,hitbyatruck10months.A:3D-GE,lowSIatcartilage;B:T1SE,linearsubcorticalsignalabno