骨的病变PPT课件.ppt

1,RoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions肿瘤及肿瘤样病变Encephalocele脑膨出Mucocele黏液囊肿Invertedpapilloma内翻乳头状瘤Malignanttumorsofthesinonasaltract鼻腔鼻窦恶性肿瘤Meningioma脑膜瘤Keratocyst角化囊肿Silentsinus静窦综合症Fibro-osseousLesions纤维-骨病变Fibrousdysplasia骨纤Osteitis骨炎Osteoma骨瘤Monitoringresponsetotherapy治疗后监测,2,Fibro-osseousLesions,Fibro-osseouslesionsareverycommonincidentalfindingsandoftenmisinterpretedastumor.CTisusuallydiagnostic,sowhenyouseeabizarrelesionattheskull-base,thinkofafibro-osseouslesionandgetanunenhancedCT.Themostcommonskullbaselesionisfibrousdysplasia,followedbyosteomas.Osteomasareusuallylocatedinthesino-nasalcavities.Fibromasarelesscommonandcanbeossifyingornon-ossifying.Malignanciesarerare.纤维-骨的病变是常见的偶然发现的病变，常常与肿瘤混淆。通常可用CT进行判断，所以当我们遇到颅底的异常病变时，要考虑骨-纤维病变，并且进行非增强CT扫描。颅底最常见骨-纤维类病变是骨纤，其次是骨瘤。骨瘤通常见于鼻腔、鼻窦。不常见的纤维瘤可以是骨化性的，也可以是非骨化性的。恶性的骨-纤维类病变罕见。,3,RoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions肿瘤及肿瘤样病变Encephalocele脑膨出Mucocele黏液囊肿Invertedpapilloma内翻乳头状瘤Malignanttumorsofthesinonasaltract鼻腔鼻窦恶性肿瘤Meningioma脑膜瘤Keratocyst角化囊肿Silentsinus静窦综合症Fibro-osseousLesions纤维-骨病变Fibrousdysplasia骨纤Osteitis骨炎Osteoma骨瘤Monitoringresponsetotherapy,4,Fibrousdysplasia,Ontheleftimagesofapatientwhowasthoughttohaveachondrosarcoma.OntheT2W-imagesthereisahypointenselesion(yellowarrow)withacysticcomponent(redarrow).Onthepre-andpost-contrastT1W-imagesthereissolidenhancementofamasswithperipheralenhancementofthecysticportion.这个患者被怀疑患有软骨肉瘤而进行磁共振检查。在T2上可见低信号病变（黄色箭头）伴囊性成分（红色箭头）。在增强前后的T1上可见肿块实性强化，囊性部分边缘强化。,5,ClassicfibrousdysplasiaonCT,Nextstep:getaCT!OnCTthisisclassicfibrousdysplasia(FD)withcorticalsparingandground-glassappearance.Manyofthefibrousdysplasialesionsintheclivus,skullbaseorsino-nasalcavityandinchildrenmayhavelargecysticcomponents,sodontletthatdissuadeyoufromthediagnosis!下一步定要进行的是CT检查。CT上可见病变表现为典型的骨纤，皮质完整和磨玻璃样改变。骨纤多位于斜坡，颅底或鼻窦、鼻腔内。儿童骨纤多含有大量囊性成分，了解这一点有助于对骨纤的判断。,6,Fibrousdysplasia(2),Ontheleftanotherexampleoffibrousdysplasia.Thislesionoriginatesfromthemiddleturbinate.这是一个骨纤的病例。病变起源于中鼻甲。,7,Fibrousdysplasia(3),Ontheleftanotherpatientreadashavingasofttissuetumor(yellowarrow)anteriortothetemporalbone.这是另外一个患者的T1，可见在颞骨前方有一个软组织肿块。,8,ThesearethecorrespondingaxialCTimagesshowingclassicfibrousdysplasiaofthesphenoidwing.Thedifferentialdiagnosisisameningioma.这个患者相应的轴位CT上可见蝶骨翼的病变表现为典型的骨纤。鉴别诊断是脑膜瘤。,9,Fibrousdysplasia(4),Ontheleftimagesofadifferentpatientwithsofttissueinthesphenoidsinusontheleft,andanabnormalityoftheleftsphenoidwing,whichisabout3timesitsnormalsizewhilstmaintainingitsnormalshape.Onthepost-contrastimagesthereissolidenhancement.Fibrousdysplasiaisaveryvascularlesionandcanenhanceavidly.不同的患者。蝶窦内可见软组织，蝶骨翼增大为正常的3倍，但形态不变。增强后可见病变呈实性强化。骨纤是富血管的病变，可以强化很明显。,10,RoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions肿瘤及肿瘤样病变Encephalocele脑膨出Mucocele黏液囊肿Invertedpapilloma内翻乳头状瘤Malignanttumorsofthesinonasaltract鼻腔鼻窦恶性肿瘤Meningioma脑膜瘤Keratocyst角化囊肿Silentsinus静窦综合症Fibro-osseousLesions纤维-骨病变Fibrousdysplasia骨纤Osteitis骨炎Osteoma骨瘤Monitoringresponsetotherapy,11,Osteitis,Thisisapatientwithosteitisofthemiddleturbinateandethmoidseptae.Notethelaminatedhighdensity,duetochronicinflammationandrecurrentperiostalreactionwithneo-osteogenesisaroundtheseptae.这个患者患有中鼻甲和筛窦内骨性分隔的骨炎。注意筛窦内的层状高密度，是由慢性炎症和反复骨膜反应伴骨性分隔新生骨形成而组成的。,12,RoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions肿瘤及肿瘤样病变Encephalocele脑膨出Mucocele黏液囊肿Invertedpapilloma内翻乳头状瘤Malignanttumorsofthesinonasaltract鼻腔鼻窦恶性肿瘤Meningioma脑膜瘤Keratocyst角化囊肿Silentsinus静窦综合症Fibro-osseousLesions纤维-骨病变Fibrousdysplasia骨纤Osteitis骨炎Osteoma骨瘤Monitoringresponsetotherapy,13,Osteoma,ThisisapatientwhohadbeenhavingbrainMRIforthepast1,5yrsforfrontalheadaches.OntheMRI(notshown)itlookedasifthepatienthadalittlemucosaldiseaseofthefrontalsinus.ThesinusCTclearlyshowsanosteomawithabonydefect(arrow)indicatingprogressivegrowth.这个患者一年半以前因头痛进行了脑部磁共振检查。在没有显示的磁共振上可见患者额窦内有一点粘膜病变。鼻窦CT清晰的显示出额窦内的骨瘤，周围的骨质缺损提示病变进行性的生长。,14,Osteomainfrontalsinus,Thislesionrequiressurgicalexcision.Note:multiplepara-nasalosteomasarefoundinGardnerssyndrome(骨肿瘤-表皮样囊肿-息肉综合征,加德纳(氏)综合征),whichalsoincludescutaneousandsofttissuestumorsinadditiontocolonicpolypswithapredilectiontomalignantdegeneration.这个病变需要手术切除。需要注意的是，许多副鼻窦骨瘤可见于加德纳综合症，即除了结肠息肉之外，还包括皮肤和软组织肿瘤，易恶变。,15,RoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions肿瘤及肿瘤样病变Encephalocele脑膨出Mucocele黏液囊肿Invertedpapilloma内翻乳头状瘤Malignanttumorsofthesinonasaltract鼻腔鼻窦恶性肿瘤Meningioma脑膜瘤Keratocyst角化囊肿Silentsinus静窦综合症Fibro-osseousLesions纤维-骨病变Fibrousdysplasia骨纤Osteitis骨炎Osteoma骨瘤Monitoringresponsetotherapy术后监测,16,Imagingcanalsobeusedtomonitortreatmentresponse.Thispatienthadaskull-baseB-celllymphoma.Pre-treatmentweseetheextentofthelesion,whichisFDG-avid影像学也可以用来监测治疗后反应。这个患者患有颅底B细胞淋巴瘤。术前CT和核素扫描可见病变范围。,17,Threemonthsintotherapytheskull-basemasshasresolved.ThereisnomorepathologicalFDGuptake,andthereisremineralisation(再矿化)ofthebone.化疗后3个月，可见颅底肿块消失。核素上无浓聚。病变周围骨质出现再矿化。,18,Thepatientonthelef