浅谈白血病骨质改变ppt课件

1、Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo1Yang chun peoples hospital 2016.12.15HomepageCopyright by ARTCOM PT All rights reserved.浅谈白血病骨质影像改变 张海明Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo2急性白血病是一组组造血组织组织的原发恶发恶性疾病；其特征是骨髓及其他造血组织组织中广泛

2、的白血病细细胞异异常增生及侵润润其他组织组织器官，导导致正常造血功能衰退，表现为现为正常造血细细胞减减少。白血病可发发生于任何年龄龄，但儿儿童及青青年好发发。异异常白血病细细胞广泛侵犯全身各脏脏器造成患者出现现不同程度出血、贫贫血、感染、发热发热、淋巴肿肿大、骨痛等。v概概述 Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo3概概述述l白血病的诊断首选骨髓检查和血液检查，但是影像学检查在诊断白血病的不同部位侵润方面具有一定的优势，对指导临床治疗有重要的意义。l由于白血病侵润范围广泛，因此，影

3、像学表现具有多样性、多发性、非特异性的特点，容易被误诊，所以一定要结合临床。Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo41 1、白血病脊柱侵、白血病脊柱侵润润l显示为椎体的骨质破坏，MRI检查具有明显的优势，破坏区T1呈斑片状低信号，T2脂肪抑制系列呈稍高信号，严重时可以导致椎体的压缩性骨质、变形；l此外还可见脊柱旁软组织肿块的形成，肿块沿着脊柱两侧纵向侵润，并且进入椎间孔，累及椎管内，导致硬膜囊受压移位，此征象可能是白血病侵润的另一种表现。Copyright by ARTCOM PT

4、 All rights reserved.www.art-com.co.krCompany LogoLogo5Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo62 2、颅颅骨的破坏骨的破坏l白血病的颅骨破坏有相似的影像表现，主要表现为软组织肿块（绿色瘤），骨质破坏多呈毛刷状、日光状，在CT骨窗上显示较清楚。l也有报道虫蚀状、融骨性骨质破坏。Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo7

5、绿绿色瘤色瘤l绿色瘤由不成熟的原粒细胞构成，细胞内含有大量含铁的髓过氧化物酶，其形成过程长，血供丰富，伴血脑屏障的破坏；l典型的CT表现为：平扫时颅内肿块可呈等或高密度，中央可呈囊性变或坏死，瘤周水肿不明显，占位效应一般较轻，增强扫描呈均一明显强化。lMRI T1呈等或稍高信号，T2呈稍低信号，增强可见明显强化。Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo8Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompan

6、y LogoLogo9l3、白血病的骨盆侵润骨盆的骨质破坏，MRI检查具有明显的优势，破坏区T1WI呈斑片状低信号，脂肪抑制系列呈不均匀高信号。Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo10NoImageCopyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo11NoImageCopyright by ARTCOM PT All rights reserved.www.art-com.co.

7、krCompany LogoLogo12NoImageCopyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo13NoImageCopyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo14对对比比贫贫血所致骨血所致骨质质改改变变贫血后，骨髓显著的增生可引起进行性骨骼改变。X线可发现颅骨及长、短骨髓腔增宽，骨质疏松；椎体鱼椎状变形；颅骨板障增厚，板障间放射状骨针，出现短发状垂直条纹。同时胸内髓外造血好发于后

8、纵隔，X线及CT典型表现为脊椎旁，两侧对称的圆形或分叶状软组织肿块，常伴肋骨后端膨大及骨质疏松。l 可以总结为骨骼变形、骨质疏松、板障增宽Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo15Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo16目前骨髓MRI已经为血液病主要无创性影像学诊断Copyright by ARTCOM PT All rights reserved.www.art-c

9、om.co.krCompany LogoLogo17Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo18Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo19Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo20Copyright by ARTCOM PT All rights reserv

10、ed.www.art-com.co.krCompany LogoLogo21Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo22Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo23Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo24Copyright by ARTCOM PT All rights reserved.www.art-com.co.krCompany LogoLogo25Copyright