（医学PPT课件）骨与关节影像诊断

骨与关节影像诊断学 1 骨关节结核 继发性结核病 血行感染儿童 青少年多见脊柱及髋 膝关节好发临床经过缓慢 2 骨关节结核 长骨干骺端结核短管状骨骨干结核关节结核 滑膜型 脊柱结核 3 骺和干骺端结核 骨质疏松类圆形限局性骨质破坏中间可有碎屑死骨周围骨增生硬化不明显 4 5 6 7 短管状骨骨干结核 四肢短管状骨儿童多见 病变多发骨质破坏在骨内呈囊性改变骨膜增生使骨干增粗骨气鼓征 8 9 10 11 Spinaventosaina22 year oldwoman Anteroposterior a andmagnified b radiographsshowextensivesoft tissueswellingwithballooningofthethirdmetacarpalofthelefthand Findingsoftuberculousarthritisarealsoseenintheadjacentjoint arrowheads 12 滑膜型关节结核 青年人髋 膝大关节常见早期关节周围软组织肿胀 骨质疏松关节面非持重边缘部先有先有骨质破坏关节间隙狭窄 13 14 15 16 Tuberculousarthritisina28 year oldmanwithpain A P a andmagnified b radiographsshowmarginalosseouserosionsofthefemoralhead arrows withrelativepreservationofthelefthipjointspace Thereisalsoevidenceofperiarticularosteopenia Tuberculousdiseasewasconfirmedwithbonebiopsy 17 脊柱结核 椎体破坏椎间隙狭窄椎旁脓肿脊柱畸形 18 19 20 21 22 Tuberculousspondylitisina17 year oldgirlwithlowbackpain a b A P a andlateral b plainradiographsshowlossofvertebralbodyheight arrowheadina sclerosisoftheendplates andanteriorscalloping arrowheadsinb c SagittalT1imageshowsfocaldecreasedsignalintensity arrow 23 SagittalT2 weighted d andGd T1 weighted e MRimagesshowincreasedsignalintensity arrow Tuberculousdiseasewasconfirmedwithbonebiopsy 24 Tuberculousspondylitiswithpsoasabscessina21 year oldwoman a MidsagittalT1 MRimagesshowlossofvertebralbodyheightanddecreasedsignalintensityatT4 arrows b CoronalT2 weightedMRimageoftheupperdorsalspineshowsbilateralparaspinalabscesses arrows withinvolvementofT4 25 c d AxialT2 weighted c andparasagittalT2 weighted d MRimagesshowalarge lobulatedparaspinalmasswithhighsignalintensitythatextendstotheposteriorparavertebralregion arrows Thediagnosiswasconfirmedwithbiopsyoftheabscess 26 骨肿瘤 良性骨软骨瘤骨巨细胞瘤恶性原发 骨肉瘤继发 骨转移瘤 27 骨软骨瘤 起于长骨干骺端 邻近骺线向外突出的骨性肿块 皮质与正常骨相连有细长的蒂和宽基底软骨帽 可发生钙化骨骺闭合即停止生长 28 29 30 31 32 33 34 35 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 36 Lateralradiographobtained2yearslatershowslesiongrowthandmineralizationthatsimulatemalignanttransformationbutrepresentonlygrowthintheimmaturepatient f Bonescandemonstratesmarkedincreaseduptakeofradionuclide g Photographofthesagittallysectionedspecimencorrelateswiththeimagingappearance revealingyellowmarrow andthethickhyalinecartilagecap arrows Fociofmineralization x arealsoseen asnotedpreviouslyintheMRimages b d 37 骨巨细胞瘤 青壮年 20 40岁 多见 好发于股骨远端 胫骨近端 桡骨远端病变在骨端 偏心性 皂泡状溶骨破坏肿瘤呈膨胀性增大 骨皮质变薄无骨膜反应一般不破坏关节面 38 39 40 41 42 BenignmetastasizingGCToftheproximaltibiaina30 year oldwoman a Anteroposteriorradiographshowsaneccentriclyticmetaepiphyseallesionextendingtosubchondralbonewithanarrowzoneoftransition arrow b Bonescintigramrevealsincreasedradionuclideuptakeperipherallyandphotopeniacentrally donutsign c CTscandemonstratesmildexpansionandsclerosisabouttheGCT arrows butnosoft tissuemass 43 OnacoronalT2WI theGCTdemonstratespredominantlyintermediatesignalintensitywithseveralhigh signal intensityfoci arrowheads correspondingtosecondaryABCregions e ChestCTscanshowsmultiplepulmonarynodulesinbothlungs arrowheads f Photographofthecoronallysectionedwholemountedspecimen H Estain revealsaGCTextendingtosubchondralbonewithABCregions white andsolidareas black 44 45 成骨肉瘤 青年男性 20岁以下 多见 好发于膝关节周围 长骨干骺端溶骨型 大片骨质破坏 骨膜反应呈 袖口征 软组织肿块明显成骨型 大量瘤骨及骨膜新生骨多为混合型 46 47 48 49 50 51 52 53 54 55 56 57 H 58 骨转移瘤 血行转移 多见于乳癌 肺癌 甲状腺癌 前列腺癌 肾癌等好发于脊柱 骨盆 颅骨等 且病变常为多发多为溶骨性破坏 可发生病理性骨折成骨转移多为前列腺癌等 在骨盆和腰椎松质骨内见到境界不清的斑片状致密影 59 60 61 62 63 64 65 66 67 metastasis 68 69 70 良 恶性骨肿瘤的鉴别 生长情况局部骨变化骨膜增生周围软组织变化 71 72 73 慢性骨关节病 退行性骨关节病类风湿性关节炎强直性脊柱炎 74 退行性骨关节病 40岁以上男性多见 脊柱和髋 膝关节好发关节间隙狭窄关节面不规则骨质增生硬化 骨赘形成 75 76 77 78 79 80 81 82 Case1 Case2 T1 T2 83 84 85 类风湿性关节炎 多见于中年女性 累及近侧指间关节 多发软组织肿胀关节间隙变窄关节面边缘骨质虫蚀样破坏关节半脱位邻近骨骼骨质疏松 86 87 88 89 RAina42 year oldwoman a Posteroanteriorradiographofthehandsshowsnoevidenceoferosionorjointspacenarrowing Coronalfat suppressedGdT1WIshowmarkedperiarticularenhancement arrows inmultiplePIPandMCPjoints 90 强直性脊柱炎 见于成年男性病变从骶髂关节开始 早期表现为关节面凹凸不平 边缘模糊 以后关节间隙逐渐狭窄 以致完全消失 形成骨性强直病变向上发展 侵犯脊柱小关节椎旁韧带钙化 呈 竹节样 改变 91 92 93 94 全身性骨病 95 佝偻病 长骨干骺端 尤其尺桡关节远端 表现典型干骺端加宽 呈杯口样凹陷先期钙化带模糊 出现毛刷样改变骨骺小 与干骺端距离加大普遍骨质密度减低 96 97 98 99 其他骨关节疾病 100 101 102 103 104 骨髓梗死 105 106 Asymptomaticmedialplica typeB 107 108 109 32 year old hitbyatruck