骨和關(guān)節(jié)影像診療培訓(xùn)課件

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7/25/20231骨和關(guān)節(jié)影像診療骨關(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7/25/20232骨和關(guān)節(jié)影像診療骺和干骺端結(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7/25/20233骨和關(guān)節(jié)影像診療7/25/20234骨和關(guān)節(jié)影像診療7/25/20235骨和關(guān)節(jié)影像診療7/25/20236骨和關(guān)節(jié)影像診療短管狀骨骨干結(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7/25/20237骨和關(guān)節(jié)影像診療7/25/20238骨和關(guān)節(jié)影像診療7/25/20239骨和關(guān)節(jié)影像診療7/25/202310骨和關(guān)節(jié)影像診療Spinaventosaina22-year-oldwoman.Anteroposterior(a)andmagnified(b)radiographsshowextensivesoft-tissueswellingwithballooningofthethirdmetacarpalofthelefthand.Findingsoftuberculousarthritisarealsoseenintheadjacentjoint(arrowheads)7/25/202311骨和關(guān)節(jié)影像診療滑膜型關(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7/25/202312骨和關(guān)節(jié)影像診療7/25/202313骨和關(guān)節(jié)影像診療7/25/202314骨和關(guān)節(jié)影像診療7/25/202315骨和關(guān)節(jié)影像診療Tuberculousarthritisina28-year-oldmanwithpain.A-P(a)andmagnified(b)radiographsshowmarginalosseouserosionsofthefemoralhead(arrows)withrelativepreservationofthelefthipjointspace.Thereisalsoevidenceofperiarticularosteopenia.Tuberculousdiseasewasconfirmedwithbonebiopsy7/25/202316骨和關(guān)節(jié)影像診療脊柱結(jié)核椎體破壞椎間隙狹窄椎旁膿腫脊柱畸形7/25/202317骨和關(guān)節(jié)影像診療7/25/202318骨和關(guān)節(jié)影像診療7/25/202319骨和關(guān)節(jié)影像診療7/25/202320骨和關(guān)節(jié)影像診療7/25/202321骨和關(guān)節(jié)影像診療Tuberculousspondylitisina17-year-oldgirlwithlowbackpain.(a,b)A-P(a)andlateral(b)plainradiographsshowlossofvertebralbodyheight(arrowheadina),sclerosisoftheendplates,andanteriorscalloping(arrowheadsinb).(c)SagittalT1imageshowsfocaldecreasedsignalintensity(arrow).7/25/202322骨和關(guān)節(jié)影像診療SagittalT2-weighted(d)andGd-T1-weighted(e)MRimagesshowincreasedsignalintensity(arrow).Tuberculousdiseasewasconfirmedwithbonebiopsy7/25/202323骨和關(guān)節(jié)影像診療Tuberculousspondylitiswithpsoasabscessina21-year-oldwoman.(a)MidsagittalT1-MRimagesshowlossofvertebralbodyheightanddecreasedsignalintensityatT4(arrows).(b)CoronalT2-weightedMRimageoftheupperdorsalspineshowsbilateralparaspinalabscesses(arrows)withinvolvementofT4.7/25/202324骨和關(guān)節(jié)影像診療(c,d)AxialT2-weighted(c)andparasagittalT2-weighted(d)MRimagesshowalarge,lobulatedparaspinalmasswithhighsignalintensitythatextendstotheposteriorparavertebralregion(arrows).Thediagnosiswasconfirmedwithbiopsyoftheabscess7/25/202325骨和關(guān)節(jié)影像診療骨腫瘤良性骨軟骨瘤骨巨細(xì)胞瘤惡性原發(fā)：骨肉瘤繼發(fā)：骨轉(zhuǎn)移瘤7/25/202326骨和關(guān)節(jié)影像診療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(xì)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7/25/202327骨和關(guān)節(jié)影像診療7/25/202328骨和關(guān)節(jié)影像診療7/25/202329骨和關(guān)節(jié)影像診療7/25/202330骨和關(guān)節(jié)影像診療7/25/202331骨和關(guān)節(jié)影像診療7/25/202332骨和關(guān)節(jié)影像診療7/25/202333骨和關(guān)節(jié)影像診療7/25/202334骨和關(guān)節(jié)影像診療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).7/25/202335骨和關(guān)節(jié)影像診療Lateralradiographobtained2yearslatershowslesiongrowthandmineralizationthatsimulatemalignanttransformationbutrepresentonlygrowthintheimmaturepatient.(f)Bonescandemonstratesmarkedincreaseduptakeofradionuclide.(g)Photographofthesagittallysectionedspecimencorrelateswiththeimagingappearance,revealingyellowmarrow(*)andthethickhyalinecartilagecap(arrows).Fociofmineralization(x)arealsoseen,asnotedpreviouslyintheMRimages(b-d).7/25/202336骨和關(guān)節(jié)影像診療骨巨細(xì)胞瘤青壯年（20~40歲）多見，好發(fā)于股骨遠(yuǎn)端、脛骨近端、橈骨遠(yuǎn)端病變?cè)诠嵌?，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7/25/202337骨和關(guān)節(jié)影像診療7/25/202338骨和關(guān)節(jié)影像診療7/25/202339骨和關(guān)節(jié)影像診療7/25/202340骨和關(guān)節(jié)影像診療7/25/202341骨和關(guān)節(jié)影像診療BenignmetastasizingGCToftheproximaltibiaina30-year-oldwoman.(a)Anteroposteriorradiographshowsaneccentriclyticmetaepiphyseallesionextendingtosubchondralbonewithanarrowzoneoftransition(arrow).(b)Bonescintigramrevealsincreasedradionuclideuptakeperipherallyandphotopeniacentrally("donutsign").(c)CTscandemonstratesmildexpansionandsclerosisabouttheGCT(arrows)butnosoft-tissuemass.7/25/202342骨和關(guān)節(jié)影像診療OnacoronalT2WI,theGCTdemonstratespredominantlyintermediatesignalintensitywithseveralhigh-signal-intensityfoci(arrowheads)correspondingtosecondaryABCregions.(e)ChestCTscanshowsmultiplepulmonarynodulesinbothlungs(arrowheads).(f)Photographofthecoronallysectionedwholemountedspecimen(H-Estain)revealsaGCTextendingtosubchondralbonewithABCregions(white*)andsolidareas(black*)7/25/202343骨和關(guān)節(jié)影像診療7/25/202344骨和關(guān)節(jié)影像診療成骨肉瘤青年男性（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7/25/202345骨和關(guān)節(jié)影像診療7/25/202346骨和關(guān)節(jié)影像診療7/25/202347骨和關(guān)節(jié)影像診療7/25/202348骨和關(guān)節(jié)影像診療7/25/202349骨和關(guān)節(jié)影像診療7/25/202350骨和關(guān)節(jié)影像診療7/25/202351骨和關(guān)節(jié)影像診療7/25/202352骨和關(guān)節(jié)影像診療7/25/202353骨和關(guān)節(jié)影像診療7/25/202354骨和關(guān)節(jié)影像診療7/25/202355骨和關(guān)節(jié)影像診療7/25/202356骨和關(guān)節(jié)影像診療H7/25/202357骨和關(guān)節(jié)影像診療骨轉(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7/25/202358骨和關(guān)節(jié)影像診療7/25/202359骨和關(guān)節(jié)影像診療7/25/202360骨和關(guān)節(jié)影像診療7/25/202361骨和關(guān)節(jié)影像診療7/25/202362骨和關(guān)節(jié)影像診療7/25/202363骨和關(guān)節(jié)影像診療7/25/202364骨和關(guān)節(jié)影像診療7/25/202365骨和關(guān)節(jié)影像診療7/25/202366骨和關(guān)節(jié)影像診療metastasis7/25/202367骨和關(guān)節(jié)影像診療7/25/202368骨和關(guān)節(jié)影像診療7/25/202369骨和關(guān)節(jié)影像診療良、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7/25/202370骨和關(guān)節(jié)影像診療7/25/202371骨和關(guān)節(jié)影像診療7/25/202372骨和關(guān)節(jié)影像診療慢性骨關(guān)節(jié)病退行性骨關(guān)節(jié)病類風(fēng)濕性關(guān)節(jié)炎強(qiáng)直性脊柱炎7/25/202373骨和關(guān)節(jié)影像診療退行性骨關(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7/25/202374骨和關(guān)節(jié)影像診療7/25/202375骨和關(guān)節(jié)影像診療7/25/202376骨和關(guān)節(jié)影像診療7/25/202377骨和關(guān)節(jié)影像診療7/25/202378骨和關(guān)節(jié)影像診療7/25/202379骨和關(guān)節(jié)影像診療7/25/202380骨和關(guān)節(jié)影像診療7/25/202381骨和關(guān)節(jié)影像診療Case1Case2,T1&T27/25/202382骨和關(guān)節(jié)影像診療7/25/202383骨和關(guān)節(jié)影像診療7/25/202384骨和關(guān)節(jié)影像診療類風(fēng)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7/25/202385骨和關(guān)節(jié)影像診療7/25/202386骨和關(guān)節(jié)影像診療7/25/202387骨和關(guān)節(jié)影像診療7/25/202388骨和關(guān)節(jié)影像診療RAina42-year-oldwoman.(a)PosteroanteriorradiographofthehandsshowsnoevidenceoferosionorjointspacenarrowingCoronalfat-suppressedGdT1WIshowmarkedperiarticularenhancement(arrows)inmultiplePIPandMCPjoints7/25/202389骨和關(guān)節(jié)影像診療強(qiáng)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(qiáng)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7/25/202390骨和關(guān)節(jié)影像診療7/25/202391骨和關(guān)節(jié)影像診療7/25/202392骨和關(guān)節(jié)影像診療7/25/202393骨和關(guān)節(jié)影像診療全身性骨病7/25/202394骨和關(guān)節(jié)影像診療佝僂病長骨干骺端（尤其尺橈關(guān)節(jié)遠(yuǎn)端）表現(xiàn)典型干骺端加寬，呈杯口樣凹陷先期鈣化帶模糊，