浅谈白血病骨质改变.ppt

Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 1 Yang chun peoples hospital 2016.12.15 Homepage Copyright by ARTCOM PT All rights reserved.浅谈白血病骨质影像改变 张海明 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 2 急性白血病是一急性白血病是一组组造血造血组织组织的原的原发恶发恶性性疾病；其特征是骨髓及其他造血疾病；其特征是骨髓及其他造血组织组织中中广泛的白血病广泛的白血病细细胞胞异异常增生及侵常增生及侵润润其他其他组织组织器官，器官，导导致正常造血功能衰退，表致正常造血功能衰退，表现为现为正常造血正常造血细细胞胞减减少。少。白血病可白血病可发发生于任何年生于任何年龄龄，但，但儿儿童及童及青青年好年好发发。异异常白血病常白血病细细胞广泛侵犯全身胞广泛侵犯全身各各脏脏器造成患者出器造成患者出现现不同程度出血、不同程度出血、贫贫血、感染、血、感染、发热发热、淋巴、淋巴肿肿大、骨痛等。大、骨痛等。概概述述 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 3 概概述述 白血病的诊断首选骨髓检查和血液检查，但是影像学检查在诊断白血病的不同部位侵润方面具有一定的优势，对指导临床治疗有重要的意义。由于白血病侵润范围广泛，因此，影像学表现具有多样性、多发性、非特异性的特点，容易被误诊，所以一定要结合临床。Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 4 1 1、白血病脊柱侵、白血病脊柱侵润润 显示为椎体的骨质破坏，MRI检查具有明显的优势，破坏区T1呈斑片状低信号，T2脂肪抑制系列呈稍高信号，严重时可以导致椎体的压缩性骨质、变形；此外还可见脊柱旁软组织肿块的形成，肿块沿着脊柱两侧纵向侵润，并且进入椎间孔，累及椎管内，导致硬膜囊受压移位，此征象可能是白血病侵润的另一种表现。Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 5 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 6 2 2、颅颅骨的破坏骨的破坏 白血病的颅骨破坏有相似的影像表现，主要表现为软组织肿块（绿色瘤），骨质破坏多呈毛刷状、日光状，在CT骨窗上显示较清楚。也有报道虫蚀状、融骨性骨质破坏。Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 7 绿绿色瘤色瘤 绿色瘤由不成熟的原粒细胞构成，细胞内含有大量含铁的髓过氧化物酶，其形成过程长，血供丰富，伴血脑屏障的破坏；典型的CT表现为：平扫时颅内肿块可呈等或高密度，中央可呈囊性变或坏死，瘤周水肿不明显，占位效应一般较轻，增强扫描呈均一明显强化。MRI T1呈等或稍高信号，T2呈稍低信号，增强可见明显强化。Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 8 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 9 3、白血病的骨盆侵润 骨盆的骨质破坏，MRI检查具有明显的优势，破坏区T1WI呈斑片状低信号，脂肪抑制系列呈不均匀高信号。Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 10 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 11 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 12 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 13 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 14 对对比比贫贫血所致骨血所致骨质质改改变变 贫血后，骨髓显著的增生可引起进行性骨骼改变。X线可发现颅骨及长、短骨髓腔增宽，骨质疏松；椎体鱼椎状变形；颅骨板障增厚，板障间放射状骨针，出现短发状垂直条纹。同时胸内髓外造血好发于后纵隔，X线及CT典型表现为脊椎旁，两侧对称的圆形或分叶状软组织肿块，常伴肋骨后端膨大及骨质疏松。可以总结为骨骼变形、骨质疏松、板障增宽 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 15 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 16 目前骨髓MRI已经为血液病主要无创性影像学诊断 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 17 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 18 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 19 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 20 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 21 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 22 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 23 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 24 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 25 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 26 Copyright by ARTCOM PT All rights reserved.www.art-com.co.kr Company LogoLogo 27 谢 谢 ！2016-12-15