股骨头水肿鉴别诊断英文课件.ppt

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1、FemoralheadedemaDifferentialdiagnosisBrunoVandeBerg,FrédéricLecouvet,BaudouinMaldague,JacquesMalghemStLucUniversityhospital,Brussels,BelgiumDefinitionHistologyDifferentialdiagnosisBonemarrowedemaofthefemoralheadBonemarrowedema:Agenerictermusedbyradiologiststodescribealesionpatter

2、nthatsuggestsanongoingabnormalprocessinthebonemarrowatMRIModeratedecreaseinsignalintensityonT1–notverylowIll-delimited–nosharpmarginsSubchondralareainvolvement-mayextendinfemoralneckBonemarrowedemaofthefemoralheadT1IntermediatetohighonSET2T1T2T1T2T1+CVerylowsignalSharpmarginsSlig

3、htdecreasenomarginssubchondralEdemaNOTedemaDefinitionHistologyDifferentialdiagnosisBonemarrowedemaofthefemoralhead« Bonemarrowedema »asdescribedbytheradiologists….Bonemarrowedemaasdescribedbytheradiologistsdoesnotcorrespondtoedemaforthepathologists!Findingsathistopathologyin« bon

4、emarrowedema »medullaryspaceinfiltrationbyconnectivetissue,inflammatorycells,edema,necrosisabnormaltrabeculaefatcellsalteration….nonspecificmicroscopicfindingsBonemarrowedemaofthefemoralhead:Anonspecificpatternofepiphysealmarrowalterationthatdevelopsinthemedullarycavityinresponse

5、todifferentinsults.Fem.headlesionsDefinitionHistologyDifferentialdiagnosisBone/marrowCartilageSynoviumFem.headlesionsDefinitionHistologyDifferentialdiagnosisBonemarrowCartilageSynoviumHipdiseasesTBMEsyndromeNecrosisFractureOsteoarthritisOAvariants>55yOA(+variants)OsteonecrosisFra

6、ctures<55yOA(+variants)OsteonecrosisFracturesTransientBMETr.osteoporosis>55y.Osteoarthritis(andvariants)OsteonecrosisInsufficiencyfracturesFemoralheadedemaSubchondralIll-delimitedModeratedecreaseinsignalOsteoarthritisT1Lookatthecartilage!Lookattheacetabulum!Nottrueedema(cysts)T1F

7、SPD55y.OsteoarthritisosteoarthritisvariantsosteonecrosisinsufficiencyfracturesFemoralheadedema+3months+6monthsRapidlydestructiveosteoarthritisofthehipJointspacelossinlessthan1yearMimicksinfection/neuro-arthropathyNoosteophyteSubchondralIll-delimitedModeratedecreaseinsignalT1T1Car

8、tilagedestructionNospontaneoushealingT1F