骨關(guān)節(jié)化膿性炎癥 骨結(jié)核教材資料

骨關(guān)節(jié)化膿性炎癥

骨結(jié)核與骨腫瘤中山大學孫逸仙紀念醫(yī)院放射科龔舒骨、關(guān)節(jié)感染性疾病化膿性骨髓炎化膿性關(guān)節(jié)炎骨關(guān)節(jié)結(jié)核：掌握脊柱結(jié)核關(guān)節(jié)結(jié)核化膿性骨髓炎、關(guān)節(jié)炎股骨急性化膿性骨髓炎—X線、MRIFS-T2WI右側(cè)脛骨急性化膿性骨髓炎—MRIFS-T2WIT1WICT+C

CT+C

股骨近段急性化膿性骨髓炎軟組織膿腫膿腔膿腫壁男性,41歲，慢性化膿性骨髓炎（顯示左股骨上段病變）同前病例，男性,41歲，慢性化膿性骨髓炎（顯示左股骨下段病變）同一病例的CT軸位（橫斷位）片同一病例的CT冠狀位重建右側(cè)尺骨慢性化膿性骨髓炎--X線36歲女性，左側(cè)下頜骨慢性化膿性骨髓炎同一病人:CT-VRTBrodie骨膿腫--慢性局限性骨膿腫

–X線SAGT1WISAGT2WISAGT1WI+CBrodie骨膿腫膿腫壁：MRI增強后可見環(huán)形強化環(huán)形骨質(zhì)硬化圓形透亮區(qū)CTCTBrodie骨膿腫TRAT1WITRAT2WITRAT1WI+C環(huán)形骨質(zhì)硬化透亮區(qū)男，13歲，左髖關(guān)節(jié)化膿性關(guān)節(jié)炎–X線正位蛙位男，13歲，左髖關(guān)節(jié)化膿性關(guān)節(jié)炎

–MRI（同上一病例）FS-T1WI+CFS-T2WIFS-T1WI骨、關(guān)節(jié)結(jié)核化膿性關(guān)節(jié)炎與關(guān)節(jié)結(jié)核的鑒別要點

鑒別要點化膿性關(guān)節(jié)炎關(guān)節(jié)結(jié)核臨床急（數(shù)天到數(shù)周）、發(fā)展快，發(fā)熱，紅、腫、熱、痛緩慢（數(shù)月到1年以上），關(guān)節(jié)疼痛和梭形腫脹關(guān)節(jié)改變軟骨較早破壞、關(guān)節(jié)間隙變窄軟骨較晚破壞骨質(zhì)破壞關(guān)節(jié)承重面關(guān)節(jié)非承重面骨質(zhì)、軟組織改變破壞與增生同時存在骨質(zhì)疏松僅見于早期，少有患肢軟組織萎縮破壞與骨質(zhì)疏松，少見骨質(zhì)增生，可有患肢軟組織萎縮疾病后遺骨性強直纖維強直胸椎結(jié)核伴冷膿腫男，15歲，胸椎多椎體結(jié)核（中心型）—MRIT1WI+CT1WIT1WIT2WI男，15歲，同上例，合并左橫突結(jié)核（附件型）—CT女，27歲，第7-9胸椎結(jié)核（前縱韌帶下型）—X線T2WIT1WIT1WI+CT2WI女，50歲，L1椎體結(jié)核（邊緣型）—MRI骨腫瘤與腫瘤樣病變掌握內(nèi)容:骨巨細胞瘤骨囊腫骨肉瘤骨轉(zhuǎn)移瘤鑒別診斷骨囊腫骨巨細胞瘤年齡青少年骺板愈合后癥狀無局部疼痛、腫脹、壓痛部位干骺端骨端生長多位于中央、長軸與骨骼長軸一致偏心性生長內(nèi)部囊性實性或囊實性骨壁光滑、無骨嵴多有骨嵴，似分隔或分房狀M,20歲，右下肢局部疼痛右側(cè)股骨外側(cè)髁骨巨細胞瘤CTofthesamepatientCorSagM,10-yearold左肩關(guān)節(jié)疼痛左側(cè)肱骨骨囊腫合并骨折右肱骨骨巨細胞瘤合并動脈瘤樣骨囊腫—X線右側(cè)肱骨骨囊腫合并病理性骨折骨巨細胞瘤病理分級I級：良性II級：潛在惡性III級：惡性右側(cè)脛骨骨巨細胞瘤(gradeII)右側(cè)脛骨骨巨細胞瘤(gradeIII)男，31歲，左肱骨骨巨細胞瘤（Grade3）—X線、MRIT1WI+CT1WI男，31歲，左肱骨高級別骨巨細胞瘤—MRIT2WI男，27歲，左肱骨上端骨巨細胞瘤合并病理骨折—MRIT1WI+CT1WIFS-T2WI男，7歲，左肱骨中上段骨囊腫--MRIFS-T2WIT1WI+C第二趾近節(jié)趾骨骨巨細胞瘤—X線M,14歲.發(fā)現(xiàn)右肩腫塊來診CTofthesamepatientCORSofttissuewindowBonewindowSAGSofttissuewindowBonewindowTRABonewindowMRIofthesamepatientT2-SPIRCORT1-WATS+CCORT1-WATS+CSAGT1-WATSTRAT1-WATS+CTRA影像所見：右側(cè)肱骨上段可見多發(fā)不規(guī)則片狀骨質(zhì)破壞區(qū)，并見片狀、云絮狀高密度瘤骨形成，肱骨頭處部分皮質(zhì)中斷，骨皮質(zhì)外可見明顯層狀骨膜增生，并見Codman’三角形成。周圍軟組織腫脹，期內(nèi)亦可見片絮狀高密度瘤骨形成。余右肩關(guān)節(jié)骨質(zhì)尚完整，未見明確骨質(zhì)破壞，右肩關(guān)節(jié)間隙未見增寬或狹窄，其內(nèi)未見異常密度影。影像診斷：右側(cè)肱骨上段骨肉瘤（混合型）。右股骨骨肉瘤（混合型）—X線股骨骨肉瘤（混合型）—X線股骨骨肉瘤—MRIT1WIT1WI股骨骨肉瘤—MRIFS-T1WI+C女，20歲，右下頜骨骨肉瘤（成骨型）—CT鑒別診斷骨肉瘤化膿性骨髓炎急性發(fā)作史無有病變范圍局限有向全骨蔓延趨勢瘤骨有無骨膜反應(yīng)常被腫瘤破壞不常被破壞骨質(zhì)增生輕與骨質(zhì)破壞同步顱骨多發(fā)骨轉(zhuǎn)移瘤男，30歲，轉(zhuǎn)移瘤（陰莖Ca）--X線女，48歲，轉(zhuǎn)移瘤（乳Ca）--X線脊柱成骨性轉(zhuǎn)移瘤(L4)M,53yrMetastasisofT10spineT1W-SAGT2W-SPIRSAGT2W-TRAT1W-TRA+CMRIofthesamepatient肺癌溶骨性骨轉(zhuǎn)移X-rayfindametastasisinT12(the12ththoracicvertebra)Compressfracture肺癌溶骨性骨轉(zhuǎn)移CT發(fā)現(xiàn)更多病變（多個椎體受累）Caseanalysis

F,16-yearsoldpresentwithpaininherleftankleformonthsAPradiographoftheankle:Normalornot?case1CaseanalysisNopositivefindinginAPradiographT2W-SPIRT1W-SPIR+cCaseanalysiscase1ThesamepatientCoronalT2-weightedfatsuppressedMRIshowshighsignalinthedistalendofthefibulawithsoft-tissueedemaaround.CoronalT1-weightedfat-suppressedMRIfollowinggadoliniuminjectionshowsenhancementinthelesion.case1AfterantibiotictherapyforafewweeksCaseanalysisCoronalT2-weightedfatsuppressedMRIshowsmildmarrowedemainthedistalendofthefibula

T2W-SPIRT1WX-rayascleroticriminthedistalendofthefibulaWhat’syouranswerforcase1?

CaseanalysisDiscussionofthiscaseAcuteandshorthistoryEarlyX-raymaybenormalThemostsensitivemethodstodetectanacuteosteomyelitisisMRInosoft-tissuemassAfterantibiotictherapy,marrowedemawouldbelightenAcuteosteomyelitis

Brodieabscessintherightintertrochantericcrest:presentsasaroundtoovoidradiolucencywithathickscleroticrim.CaseanalysisCase2Male,12-yearsold,presentwithpain

intherightthighformorethan1yearScleroticrimCaseanalysisCase2MRIofthesamepatientT1WISAGT2WISPIRSAGT2WISPIR+CSAGT2WISPIR+CTRA

*aprimarychronicpyogenicinfection,usuallyproducingaroundabscesscavity1-4cmindiameterCase2:BrodieabscessCaseanalysis

generallyappearsasadefectwithoutcontrastenhancement

However,thedefectcanenhanceiftheabscesscavityisfilledwithinfectiousgranulationtissueratherthanpus(rare)*ThelesionhashighsignalintensityonSTIRandT2-weightedimages*Thescleroticrimisoflowsignalintensity,butmayfaintlyenhancewithcontrastCaseanalysisWhat’syourdiagnosisforthiscase?Whatcharacteristicsigncanyoufindtosupportyourdiagnosis?Case3sequestrumChronicosteomyelitisNarrowingandclosingofthemedullarycavitySequestrum：

anecroticosseousfragmentcompletelysurroundedbytheinfectiousprocess（granulationtissue/pus）

(=radiolucentrim)Discussionofcase3：X-rayfeaturesofchronicosteomyelitis:*

irregularsclerosiswithlossofthetrabecularstructure*

inadditiontoosteolyticdestructionandsolidperiostealreactions*SequestrationisalsopossibleCaseanalysisCase4Female,78-yearold,prestentwithPaininherbackCaseanalysisOsteolyticdestructionwithoutscleroticreactionoftheL3~4CTofthesamepatientCaseanalysisCase4OsteolyticdestructionwithoutscleroticreactionPsoasabscesssequestrumMRIofthesamepatientCaseanalysisCase4PsoasabscessWithperipheralenhancementT2WISAGT1WISAGT1WI+CSAGT2WIT1WI+Cwhat’syouranswerforthiscase?CaseanalysisTuberculosisinL3~4CaseanalysisCase5APandlateralradiographsofthekneeIvory-liketumorboneintheproximalendofthetibia

CaseanalysisCase5

CTofthesamepatientTRACORSAGI