骨与关节影像诊断

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1、骨与关节影像诊断学（二）北京大学第一医院医学影像科王继琛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Spinaventosaina22-year-oldwoman.Anteroposterior(a)andmagnified(b)radiographsshowextensivesof

2、t-tissueswellingwithballooningofthethirdmetacarpalofthelefthand.Findingsoftuberculousarthritisarealsoseenintheadjacentjoint(arrowheads)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Tuberculousarthritisina28-year-oldmanwithpain.A-P(a)andmagnified(b)radiographsshowmargina

3、losseouserosionsofthefemoralhead(arrows)withrelativepreservationofthelefthipjointspace.Thereisalsoevidenceofperiarticularosteopenia.Tuberculousdiseasewasconfirmedwithbonebiopsy脊柱结核椎体破坏椎间隙狭窄椎旁脓肿脊柱畸形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

7、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Benignosteochondromaofthetibiaina15-yrsboywithlesiongrowth.(a)Initialradiographshowspathognomonicfeaturesofosteochondroma.Thecortical(solidarrows)andmedullary(*)continuitywiththetibiawasseenonradiographs.Thecartilagecapisnotmineralizedandcannotbese

8、en.(b-d)AxialMRimagesT1obtainedbe