骨的病变ppt课件

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 sodon tletthatdissuadeyoufromthediagnosis 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 nasalosteomasarefoundinGardner ssyndrome 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 Thepatientont