【作者】 钟志伟；

【导师】 吴文娟；

【作者基本信息】 河北医科大学 ， 影像医学与核医学， 2012， 硕士

【摘要】 目的：探讨骨骼病变磨玻璃密度的影像学特点，分析磨玻璃密度影中不同种类骨骼病变所占的比例；通过分析磨玻璃密度病变的种类、部位、内部结构、CT值、边界及周围骨质改变来判断磨玻璃密度影征象在骨骼疾病诊断中的价值。方法：回顾性分析作者所在医院2003年7月～2010年7月经手术病理证实的2386例骨骼病变，选择X线平片上具有磨玻璃密度同时又具有CT作对比的病例为研究对象。设定以X线平片上具有磨玻璃密度的为磨玻璃密度组（ground-glass opacity，GGO），以CT上具有磨玻璃密度的为真性磨玻璃密度组（true ground-glass opacity，tGGO）；以X线平片上具有磨玻璃密度而CT上不具有磨玻璃密度的为假阳性磨玻璃密度组（falseground-glass opacity，fGGO）。分析X线平片上和CT上磨玻璃密度出现的差异。根据磨玻璃密度的均匀性又将tGGO又分为纯磨玻璃密度（pureground-glass opacity， pGGO）和混合磨玻璃密度(mixed ground-glassopacity，mGGO)，对pGGO组和mGGO组诊断纤维结构不良和其他疾病的差异进行卡方检验。根据mGGO所占病变体积百分比将mGGO分为mGGO所占病变体积≥50%者为mGGO-A组，＜50%者为mGGO-B组。分析mGGO-A和mGGO-B两组中病种的构成及在鉴别诊断中的价值。分析不同部位发生磨玻璃密度的特点。测量各组病种的中位CT及CT值范围。观察fGGO病变周围的硬化边和厚度、骨膜反应和骨痂的发生率，分析fGGO的形成原因。结果：2386例骨肿瘤及肿瘤样病变中，X线平片上具有磨玻璃密度的病变246例，在CT上185例具有tGGO，即X线平片上所显示的GGO有近1/4在CT扫描时并非真正的GGO。185例tGGO组病变区在CT上均包含有磨玻璃密度区，磨玻璃密度区的CT值在140～600Hu之间。依次是纤维结构不良132例（71.4%）、内生软骨瘤13例（7%）、骨肉瘤9例（4.9%）、软骨母细胞瘤7例（3.8%）、软骨肉瘤5例（2.7%）、骨母细胞瘤3例（1.6%）、慢性骨髓炎2例（1%）、软骨粘液样纤维瘤2例（1%）及其他病变共10例（5.4%）。185例tGGO中有52为pGGO，其中依次是纤维结构不良49例（94.2%）、内生软骨瘤2例（3.9%）和软骨肉瘤1例（1.9%）；133例mGGO组病变依次是纤维结构不良83例（62.4%）、内生软骨瘤11例（8.3%）、骨肉瘤9例（6.8%）、软骨母细胞瘤7例（5.3%）、软骨肉瘤4例（3%）、骨母细胞瘤3例（2.3%）及其他病变共16例（12%）。经卡方检验pGGO组中纤维结构不良的发生率大于mGGO组。95例mGGO-A组病变依次是纤维结构不良74例（77.9%）、骨肉瘤6例（6.3%）、骨母细胞瘤3例（3.2%）、内生软骨瘤2例（2.1%）、软骨肉瘤2例（2.1%）及其他病变8例（8.4%）；38例mGGO-B组病变依次是内生软骨瘤9例（23.7%）、纤维结构不良9例（23.7%）、软骨母细胞瘤7例（18.4%）、骨肉瘤3例（7.9%）、软骨肉瘤2例（5.2%）、骨囊肿2例（5.2%）及其他病变6例（15.8%）。经卡方检验mGGO-A中纤维结构不良的发生率大于mGGO-B组。185例tGGO病变共218个病灶，其中股骨100个病灶，分别是pGGO29个病灶和mGGO71个病灶。股骨100个病灶中纤维结构不良为67例。而颅面骨12个病灶分别是pGGO11个病灶和mGGO1个病灶，12个病灶中纤维结构不良11例，全部为pGGO。余106个病灶分布其他各部位。颅面骨发生pGGO的几率高，经卡方检验具有tGGO时颅面骨组发生纤维结构不良的比率高于其他部位组。61例fGGO病变区在CT上均无磨玻璃密度影，其内CT值为14.4～112Hu。其常见病变依次是纤维结构不良25例（41%）、骨囊肿9例（14.8%）、动脉瘤样骨囊肿4例（6.6%）、骨内腱鞘囊肿4例（6.6%）、朗格汉斯细胞组织细胞增生症4例（6.6%）、非骨化性纤维瘤3例（4.9%）、骨巨细胞瘤3例（4.9%）、甲状旁腺机能亢进症（泛发性纤维囊性骨炎）3例（4.9%），其他病变共5例（8.2%）。61例fGGO病变中，病变周围具有硬化边的46例（75.4%），具有骨膜反应的7例（11.5%），具有骨痂的4例（6.6%），病变内残留骨嵴1例,3例（4.9%）无硬化边、骨膜反应及骨痂。结论：在骨骼病变中，X线平片上呈现磨玻璃密度的病变，其中约1/4在CT上不呈磨玻璃密度。GGO主要见于纤维结构不良，亦可见于其他病变。CT上病变区呈现弥漫性的GGO时诊断纤维结构不良更为可靠，尤其当病变位于颅面骨时。CT上呈现磨玻璃密度影的病变区CT值在140～600Hu。X线平片上GGO的形成除与病变区自身存在的多量骨化和钙化有关外，还与病变区周围的硬化、骨膜反应等重叠有关，亦有局部病变在整体骨质密度减低衬托下形成的皮髓质模糊不清的假象。在诊断和鉴别诊断时应结合其他征象和临床表现综合分析。更多还原

【Abstract】 Objectives: To evaluate the imaging features of the ground-glass opacityof bone lesions and to observe the constituent ratio of the GGO in differentbone lesions. To assess the value of GGO in the diagnosis of bone diseases byanalyzing the internal structure, CT value, margin and distribution of thelesions.Methods: A retrospective analysis of2386cases with bone lesionsproved surgically or pathologically from July2003to July2010in ourhospital was performed. Of these cases, those with ground-glass opacity(GGO) on X-ray film and meanwhile having CT scan as a contrast werechosen as objects of study. Lesions with ground glass density shown on X-raywere described as the group of ground-glass opacity(GGO), which wascategorized into Group tGGO (true ground-glass opacity, GGO shown on CT)and Group fGGO (false ground-glass opacity, GGO presented not on CT onlyon X-ray).On the basis of the lesion features, those with tGGO weresub-categorized into two groups: pGGO (pure ground-glass opacity) andmGGO (mixed ground-glass opacity). The differences of fibrous dysplasia ofbone and other diseases between group fGGO and tGGO were compared usingchi-squared analysis. According to the proportion of GGO area within asolitary lesion, GGO lesions were further divided into two groups: groupmGGO-A was those with the GGO area not smaller than50%; groupmGGO-B was those with the GGO area smaller than50%. The constituentratio of different diseases in group mGGO-A and group mGGO-B, distributionof lesions with GGO and their values in differential diagnosis were analyzed.CT value of GGO area in different diseases were measured. The incidence andthickness of sclerotic rim around lesions with fGGO, periosteal reaction and callus was observed. Meanwhile, the cause for fGGO was analyzed.Results: Of the2386patients with bone lesions,246contained GGO onX-ray,185contained tGGO on CT.185cases of tGGO lesions，the CT value ranged from140to600Hu inthe tGGO area. The most common lesion in this group was fibrousdysplasia(132cases,71.4%）, followed by enchondroma (13,7%),osteosarcoma (9,4.9%), chondroblastoma (7,3.8%), osteosarcoma (5,2.7%),osteoblastoma (3,1.6%), chronic osteomyelitis (2,1%), Chondromyxoidfibroma (2,1%), and other diseases (10,5.4%).52cases with pGGO in decending order were fibrous dysplasia（49,94.2%）, enchondroma (2,3.9%), osteosarcoma (1,1.9%).133cases withmGGO were fibrous dysplasia（83,62.4%）, enchondroma (11,8.3%),osteosarcoma (9,6.8%), chondroblastoma (7,5.3%), chondrosarcoma (4,3%),osteoblastoma (3,2.3%), and other diseases (16,12%). The data was assessedby chi-square and it showed that the incidence of fibrous dysplasia in grouppGGO was higher than that in group mGGO.95cases in group mGGO-A were fibrous dysplasia （74,77.9%),osteosarcoma (6,6.3%), osteoblastoma (3,3.2%), enchondroma (2,2.1%), andchrondrosarcoma (2,2.1%) and other diseases (8,8.4%).38cases in groupmGGO-B ranked the top three were enchondroma (9.23.7%), fibrousdysplasia(9,23.7%) and chondroblastoma (7,18.4%), followed byosteosarcoma (3,7.9%), chondrosarcoma (2,5.2%), bone cyst (2,5.2%) andother diseases (6,15.8%). Chi-square statistics indicated that the incidenceof fibrous dysplasia in group mGGO-A was higher than that in groupmGGO-B.Among185cases of lesions with tGGO,218foci appeared. The mostcommon location of lesions was the femur with100focuses, including29withpGGO and71with mGGO. Of the100foci,67were fibrous dysplasia. Thenumber of lesions that occurred in craniofacial bone was12, including11withpGGO and1with mGGO. Of the12cases,11cases were fibrous dysplasia, allwith pGGO. The rest of106foci located in other bones. The incidence of pGGO in craniofacial bone was higher. Chi-square assessment displayed theconstituent ratio of fibrous dysplasia with pGGO in craniofacial bone washigher than in other locations.None of the61cases with fGGO showed GGO image on CT, with the CTvalue ranged from14.4to112Hu. The most common lesions in this groupwere fibrous dysplasia in25cases，followed by solitary bone cyst in9,aneurismal bone cyst in4, intraosseous ganglion cyst in4, langerhans cellhistiocytosis in4, nonossifying fibroma in3, giant cell tumor of bone in3,hyperparathyroidism in3, and other diseases in5. Of the61cases,46(75.4%)had sclerotic rim,7(11.5%) had periosteal reaction,4(6.6%) had callus,1hadresidue bone trabecula in the lesion, and3(4.9%) showed no featuresmentioned above.Conclusion: In skeletal lesions, GGO presented on X-ray filmapproximately1/4were not shown on CT. GGO mainly present in fibrousdysplasia, and also show in other lesions. Fibrous dysplasia with GGO hassome characteristic manifestation on CT and it was more reliable to bediagnosed with diffuse GGO in the lesion, especially of cranial bones. GGOwas shown on CT when CT value of the legion ranged from140to600Hu.Besides the large amounts of ossification and calcification in the lesions itself,the factors responsible for GGO on X-ray might be overlapping image causedby annular sclerotic rim around the lesion, periosteal reaction, and obscurecontrastive attenuation of cortex and medullary which occurs in the situationof whole bone density decrease. Thus the differential diagnosis should becombined with other signs and clinical features.更多还原