淺談白血病骨質(zhì)改變

1、copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo1yang chun peoples hospital 2016.12.15homepagecopyright by artcom pt all rights reserved.淺談白血病骨質(zhì)影像改變 copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo2 急性白血病是一組組造血組織組織的原發(fā)惡發(fā)惡性疾??；其特征是骨髓及其他造血組組織織中廣泛的白

2、血病細(xì)細(xì)胞異異常增生及侵潤(rùn)潤(rùn)其他組織組織器官，導(dǎo)導(dǎo)致正常造血功能衰退，表現(xiàn)為現(xiàn)為正常造血細(xì)細(xì)胞減減少。 白血病可發(fā)發(fā)生于任何年齡齡，但兒兒童及青青年好發(fā)發(fā)。異異常白血病細(xì)細(xì)胞廣泛侵犯全身各臟臟器造成患者出現(xiàn)現(xiàn)不同程度出血、貧貧血、感染、發(fā)熱發(fā)熱、淋巴腫腫大、骨痛等。v概概述 copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo3概概述述l白血病的診斷首選骨髓檢查和血液檢查，但是影像學(xué)檢查在診斷白血病的不同部位侵潤(rùn)方面具有一定的優(yōu)勢(shì)，對(duì)指導(dǎo)臨床治療有重要的意義。l由于白血病侵潤(rùn)范圍廣泛，因此，影像

3、學(xué)表現(xiàn)具有多樣性、多發(fā)性、非特異性的特點(diǎn)，容易被誤診，所以一定要結(jié)合臨床。copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo41 1、白血病脊柱侵、白血病脊柱侵潤(rùn)潤(rùn)l顯示為椎體的骨質(zhì)破壞，mri檢查具有明顯的優(yōu)勢(shì)，破壞區(qū)t1呈斑片狀低信號(hào)，t2脂肪抑制系列呈稍高信號(hào)，嚴(yán)重時(shí)可以導(dǎo)致椎體的壓縮性骨質(zhì)、變形；l此外還可見(jiàn)脊柱旁軟組織腫塊的形成，腫塊沿著脊柱兩側(cè)縱向侵潤(rùn)，并且進(jìn)入椎間孔，累及椎管內(nèi)，導(dǎo)致硬膜囊受壓移位，此征象可能是白血病侵潤(rùn)的另一種表現(xiàn)。copyright by artcom pt

4、all rights reserved.www.art-com.co.krcompany logologo5copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo62 2、顱顱骨的破壞骨的破壞l白血病的顱骨破壞有相似的影像表現(xiàn)，主要表現(xiàn)為軟組織腫塊（綠色瘤），骨質(zhì)破壞多呈毛刷狀、日光狀，在ct骨窗上顯示較清楚。l也有報(bào)道蟲(chóng)蝕狀、融骨性骨質(zhì)破壞。copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo7綠

5、綠色瘤色瘤l綠色瘤由不成熟的原粒細(xì)胞構(gòu)成，細(xì)胞內(nèi)含有大量含鐵的髓過(guò)氧化物酶，其形成過(guò)程長(zhǎng)，血供豐富，伴血腦屏障的破壞；l典型的ct表現(xiàn)為：平掃時(shí)顱內(nèi)腫塊可呈等或高密度，中央可呈囊性變或壞死，瘤周水腫不明顯，占位效應(yīng)一般較輕，增強(qiáng)掃描呈均一明顯強(qiáng)化。lmri t1呈等或稍高信號(hào)，t2呈稍低信號(hào)，增強(qiáng)可見(jiàn)明顯強(qiáng)化。copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo8copyright by artcom pt all rights reserved.www.art-com.co.krcompany

6、 logologo9l3、白血病的骨盆侵潤(rùn)骨盆的骨質(zhì)破壞，mri檢查具有明顯的優(yōu)勢(shì)，破壞區(qū)t1wi呈斑片狀低信號(hào)，脂肪抑制系列呈不均勻高信號(hào)。copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo10copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo11copyright by artcom pt all rights reserved.www.art-com.co.krcompany logol

7、ogo12copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo13copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo14對(duì)對(duì)比比貧貧血所致骨血所致骨質(zhì)質(zhì)改改變變貧血后，骨髓顯著的增生可引起進(jìn)行性骨骼改變。x線可發(fā)現(xiàn)顱骨及長(zhǎng)、短骨髓腔增寬，骨質(zhì)疏松；椎體魚(yú)椎狀變形；顱骨板障增厚，板障間放射狀骨針，出現(xiàn)短發(fā)狀垂直條紋。同時(shí)胸內(nèi)髓外造血好發(fā)于后縱隔，x線及ct典型表現(xiàn)為脊椎旁，兩側(cè)對(duì)稱的圓形或分葉狀軟

8、組織腫塊，常伴肋骨后端膨大及骨質(zhì)疏松。l 可以總結(jié)為骨骼變形、骨質(zhì)疏松、板障增寬copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo15copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo16目前骨髓mri已經(jīng)為血液病主要無(wú)創(chuàng)性影像學(xué)診斷copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo17cop

9、yright by artcom pt all rights reserved.www.art-com.co.krcompany logologo18copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo19copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo20copyright by artcom pt all rights reserved.www.art-com.co.krcompany l

10、ogologo21copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo22copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo23copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo24copyright by artcom pt all rights reserved.www.art-com.co.krcompany logologo25copyright by