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1、骨與關(guān)節(jié)影像診斷學(xué) （二）北京大學(xué)第一醫(yī)院醫(yī)學(xué)影像科王繼琛骨關(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(jiàn)脊柱及髖、膝關(guān)節(jié)好發(fā)臨床經(jīng)過(guò)緩慢骨關(guān)節(jié)結(jié)核長(zhǎng)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短管狀骨骨干結(jié)核四肢短管狀骨兒童多見(jiàn)，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Spinaventosaina22-year-oldwoman.Anteroposterior(a)andmagnified(b)radiographsshowextensivesof
2、t-tissueswellingwithballooningofthethirdmetacarpalofthelefthand.Findingsoftuberculousarthritisarealsoseenintheadjacentjoint(arrowheads)滑膜型關(guān)節(jié)結(jié)核青年人髖、膝大關(guān)節(jié)常見(jiàn)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Tuberculousarthritisina28-year-oldmanwithpain.A-P(a)andmagnified(b)radiographsshowmargina
3、losseouserosionsofthefemoralhead(arrows)withrelativepreservationofthelefthipjointspace.Thereisalsoevidenceofperiarticularosteopenia.Tuberculousdiseasewasconfirmedwithbonebiopsy脊柱結(jié)核椎體破壞椎間隙狹窄椎旁膿腫脊柱畸形Tuberculousspondylitisina17-year-oldgirlwithlowbackpain.(a,b)A-P(a)andlateral(b)plai
4、nradiographsshowlossofvertebralbodyheight(arrowheadina),sclerosisoftheendplates,andanteriorscalloping(arrowheadsinb).(c)SagittalT1imageshowsfocaldecreasedsignalintensity(arrow).SagittalT2-weighted(d)andGd-T1-weighted(e)MRimagesshowincreasedsignalintensity(arrow).Tuberculousdisease
5、wasconfirmedwithbonebiopsyTuberculousspondylitiswithpsoasabscessina21-year-oldwoman.(a)MidsagittalT1-MRimagesshowlossofvertebralbodyheightanddecreasedsignalintensityatT4(arrows).(b)CoronalT2-weightedMRimageoftheupperdorsalspineshowsbilateralparaspinalabscesses(arrows)withinvolveme
6、ntofT4.(c,d)AxialT2-weighted(c)andparasagittalT2-weighted(d)MRimagesshowalarge,lobulatedparaspinalmasswithhighsignalintensitythatextendstotheposteriorparavertebralregion(arrows).Thediagnosiswasconfirmedwithbiopsyoftheabscess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)移瘤骨軟骨瘤起于長(zhǎng)骨干骺端，鄰近骺線向外突出的骨性腫塊，皮質(zhì)
7、與正常骨相連有細(xì)長(zhǎng)的蒂和寬基底軟骨帽，可發(fā)生鈣化骨骺閉合即停止生長(zhǎng)Benignosteochondromaofthetibiaina15-yrsboywithlesiongrowth.(a)Initialradiographshowspathognomonicfeaturesofosteochondroma.Thecortical(solidarrows)andmedullary(*)continuitywiththetibiawasseenonradiographs.Thecartilagecapisnotmineralizedandcannotbese
8、en.(b-d)AxialMRimagesT1obtainedbe
