眼眶骨嗜酸性肉芽肿的影像学诊断

摘要

Objective To improve the diagnostic level of orbital eosinophilic granuloma by discussing the clin-ical characteristics and imaging features. Methods Retrospective analysis of the clinical features, imaging character-istics and circumstances after review in 8 patients with eosinophilic granuloma, which confirmed by the surgery and pathology from September 2009 to Feburary 2013 in Shanxi Eye Hospital. Results In CT manifestations, 3 cases showed osteolytic destruction with unclear edge like a map, hardened edge, bone fragments, soft tissue mass around, and the mass range was larger than the range of bone destruction. Two cases showed vermiform destruction of bone. Three cases showed farfetched like bone destruction, sharp boundaries, no hardened edge, it was filled with soft tissue, and broke the bone, dura and the skull violations, outside the orbit to the outer plate growth. The MR performance had T1 long T2 signal intensity, T2 fat saturation sequence lesion showed low signal, along with high signal. Postoperative follow-up was two years. Three cases had no obvious difference from the normal ones. Five cases with titanium mesh fixed well. Eight cases showed no recurrence. Conclusion Orbital eosinophilic granuloma and other malignant le-sions are easy to be confused. The correct diagnosis relies on combination of clinical, radiological, pathological as-pects. A comprehensive detailed analysis is helpful to improve the diagnostic level of this disease.%目的：探讨眼眶骨嗜酸性肉芽肿的CT表现及临床特点,以提高对本病的诊断水平。方法回顾性分析2009年9月至2013年2月经手术及病理证实的8例嗜酸性肉芽肿患者的临床特点、影像学特征及术后复查情况。结果 CT表现：3例呈溶骨性破坏，边界不清，呈地图样，边缘骨质硬化，内可见碎骨片，周围可见软组织肿块，肿块范围大于骨质破坏范围；2例呈虫蚀样骨质破坏；3例表现为穿凿样骨质破坏，边界锐利，无明显硬化边，其内被软组织密度影充填，并突破骨质，侵犯硬脑膜及颅骨内、外板向眶内外生长。磁共振成像多表现为等或长T1长T2信号影，T2压脂序列病灶呈低信号，其间可夹杂高信号。术后随访2年，3例病变基本愈合，与正常骨质无明显区别，5例钛网固定良好，8例均未见复发。结论眼眶骨嗜酸性肉芽肿易与其他恶性病变相混淆，正确诊断有赖于临床、影像学、病理相结合，综合细致的全面分析有利于提高对本病的诊断水平。