四肢骨影像学类死骨征象的临床意义分析

doi:DOI:10.12117/jccmi.2018.12.012

Abstract
Figure/Table
References (0)
Related Citation (15)

Download: PDF (0 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective: To study the differences of the occurrence rate of “sequestrum” sign in different diseases of extremity. Methods: Patients with limb bone diseases and bone destructive lesions in our hospital from 2008 to 2016 were retrospectively analyzed. Two hundred and fifty-three patients with 13 types of diseases that proved by pathology or clinical follow-up were included in the observation. CT examination was performed in all cases, radiography in 163 cases, MRI in 144 cases, and all the three kinds of examination was performed in 66 cases. CT images were used to observe the occurrence of the “sequestrum” sign and to calculate the occurrence rate of the sign. χ2 test was used to perform statistical analysis. Results: “Sequestrum” sign appeared in 92.3%(12/13) of the disease types and in 43.1%(109/253) of all the cases. But occurrence rate of “sequestrum” sign differed in different types of the disease, osteomyelitis 52.9%(27/51), skeletal tuberculosis 70.0%(7/10), metastatic carcinoma 47.1%(48/102), fibrous dysplasia 32.1%(9/28), and giant cell tumor of bone 22.2%(6/27). The occurrence rate was the highest in bone tuberculosis(χ2=11.532, P<0.05), followed by osteomyelitis and bone metastases. Other types with less cases also showed “sequestrum” sign, including 3 cases of Langerhans cell histiocytosis(3/8), 1 case of primary lymphoma of bone(1/6), 2 cases of malignant fibrous tumors(2/5), 3 cases of aneurysmal bone cyst(3/5), 1 case of osteofibrous dysplasia(1/8), 1 case of angiosarcoma of bone(1/1), and 1 case of fibrosarcoma of bone(1/1). The sign was not found in the only one case of primitive neuroectodermal tumor(PNET)(0/1). Conclusion: “Sequestrum” sign can be seen in vast majority of limb bone disease of benign and malignant bone destructive lesions, but it is seen in skeletal tuberculosis most commonly, followed by osteomyelitis and bone metastases. We should combine this sign with other signs to make qualitative diagnosis and avoid misdiagnosis.

Key words： Bone diseases Tomography, X-ray computed Magnetic resonance imaging

Received: 05 January 2018

PACS:	Ｒ681
	Ｒ814.42
	Ｒ445.2

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	ZHANG Yuan
	CHEN Hai-song
	FENG Wei-hua
	ZHOU Rui-zhi

Cite this article:

ZHANG Yuan,CHEN Hai-song,FENG Wei-hua, et al. The clinical significance of the sequestrum sign in limb bone imaging[J]. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(12): 884-888.

URL:

http://www.jccmi.com.cn/EN/DOI:10.12117/jccmi.2018.12.012 OR http://www.jccmi.com.cn/EN/Y2018/V29/I12/884

[1]Jennin F, Bousson V, Parlier C, et al. Bony sequestrum: a radiologic review[J]. Skeletal Radiol, 2011, 40(8): 963-975. [2]Liu PT, Chivers FS, Roberts CC, et al. Imaging of osteoid osteoma with dynamic gadolinium-enhanced MR imaging[J]. Radiology, 2003, 227(3): 691-700. [3]Resnick D. Tumors and tumor-like lesions of bone: imaging and pathology of specific lesions[M]//Diagnosis of bone and joint disorders. 4th ed. Philadelphia: Saunders, 2002: 3763-4128. [4]Kroon HM, Schurmans J. Osteoblastoma: clinical and radiologic findings in 98 new cases[J]. Radiology, 1990, 175(3): 783-790. [5]Yamaguchi T, Dorfman HD. Radiographic and histologic patterns of calcification in chondromyxoid fibroma[J]. Skeletal Radiol, 1998, 27(10): 559-564. [6]Campbell RS, Grainger AJ, Mangham DC, et al. Intraosseous lipoma: report of 35 new cases and a review of the literature[J]. Skeletal Radiol, 2003, 32(4): 209-222. [7]Abdelwahab IF, Hermann G, Klein MJ, et al. Fibromyxoma of bone[J]. Skeletal Radiol, 1991, 20(2): 95-98. [8]De Backer AI, Mortele KJ, Vanhoenacker FM, et al. Imaging of extraspinal musculoskeletal tuberculosis[J]. Eur J Radiol, 2006, 57(1): 119-130. [9]Shanley DJ. Tuberculosis of the spine: imaging features[J]. AJR, 1995, 164(3): 659-664. [10]Ousehal A, Adil A, Abdelouafi A, et al. Centrosomatic spinal tuberculosis: radiographic features in 10 cases[J]. J Neuroradiol, 2000, 27(4): 247-252. [11]Resnick D. Osteomyelitis, septic arthritis, and soft-tissue infection[M]//Diagnosis of bone and joint disorders. 4th ed. Philadelphia: Saunders, 2002: 2372-2550. [12]Rosen IW, Nadel HI. Button sequestrum of the skull[J]. Radiology, 1969, 92(5): 969-971. [13]Hindman BW, Thomas RD, Young LW, et al. Langerhans cell histiocytosis: unusual skeletal manifestations observed in thirty-four cases[J]. Skeletal Radiol, 1998, 27(4): 177-181. [14]Pratt AD, Felson B, Wiot JF, et al. Sequestrum formation in fibrous dysplasia[J]. Am J Roentgenol Radium Ther Nucl Med, 1969, 106(1): 162-165. [15]Mulligan ME, Mcrae GA, Murphey MD. Imaging features of primary lymphoma of bone[J]. AJR, 2013, 173(6): 1691-1697. [16]Mulligan ME, Kransdorf MJ. Sequestra in primary lymphoma of bone: prevalence and radiologic features[J]. AJR, 1993, 160(6): 1245-1248. [17]Helms CA, Jeffrey RB, Wing VW. Computed tomography and plain film appearance of a bony sequestration: significance and differential diagnosis[J]. Skeletal Radiol, 1987, 16(2): 117-120. [18]Prasad A, Manchanda S, Sachdev N, et al. Imaging features of pediatric musculoskeletal tuberculosis[J]. Pediatr Radiol, 2012, 42(10): 1235-1249. [19]De Backer AI, Vanhoenacker FM, Sanghvi DA. Imaging features of extraaxial musculoskeletal tuberculosis[J]. Indian J Radiol Imaging, 2009, 19(3): 176-186. [20]Teo HE, Peh WC. Skeletal tuberculosis in children[J]. Pediatr Radiol, 2004, 34(11): 853-860. [21]Burrill J, Williams CJ, Bain G, et al. Tuberculosis: a radiologic review[J]. Radiographics, 2007, 27(5): 1255-1273. [22]Maurer J, Lehmann-Beckow D, Vosshenrich R, et al. The place of computed tomography and magnetic resonance tomography in the diagnosis of bone sequestra[J]. Aktuelle Radiol, 1992, 2(6): 345-349. [23]Malcius D, Jonkus M, Kuprionis G, et al. The accuracy of different imaging techniques in diagnosis of acute hematogenous osteomyelitis[J]. Medicina(Kaunas), 2009, 45(8): 624-631. [24]Bires AM, Kerr B, George L. Osteomyelitis: an overview of imaging modalities[J]. Crit Care Nurs Q, 2015, 38(2): 154-164. [25]Gold RH, Hawkins RA, Katz RD. Bacterial osteomyelitis: findings on plain radiography, CT, MR, and scintigraphy[J]. AJR, 1991, 157(2): 365-370. [26]Unger E, Moldofsky P, Gatenby R, et al. Diagnosis of osteomyelitis by MR imaging[J]. AJR, 1988, 150(3): 605-610. [27]Chiappini E, Mastrangelo G, Lazzeri S. A case of acute osteomyelitis: an update on diagnosis and treatment[J]. Int J Environ Res Public Health, 2016, 13(6): E539. [28]Sartoris DJ, Resnick D, Guerra JJ. Vertebral venous channels: CT appearance and differential considerations[J]. Radiology, 1985, 155(3): 745-749. [29]Jhamb A, Mohanty S, Jhamb PA. Craniofacial fibrous dysplasia[J]. J Oral Maxillofac Pathol, 2012, 16(3): 465-469. [30]Krasnokutsky MV. The button sequestrum sign[J]. Radiology, 2005, 236(3): 1026-1027. [31]Azouz EM, Saigal G, Rodriguez MM, et al. Langerhans’ cell histiocytosis: pathology, imaging and treatment of skeletal involvement[J]. Pediatr Radiol, 2005, 35(2): 103-115.