骨髓转换及骨髓病变MR课件

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,骨髓转换及骨髓病变MR,骨髓转换及骨髓病变MR,1,骨髓转换,骨髓转换,2,骨髓组成,正常骨髓三种主要成分：骨髓组织、脂肪细胞及骨小梁；,骨髓组织与脂肪细胞相互比例关系随年龄增大及人体对血的需求而改变；,红骨髓：40%水+40%脂肪+20%蛋白+富含静脉窦系统的血管网；,黄骨髓：15%水+80%脂肪+5%蛋白+稀少静脉窦血管网；,骨髓组成正常骨髓三种主要成分：骨髓组织、脂肪细胞及骨小梁；,3,红黄骨髓MR信号特点,红骨髓：T1WI中或稍高信号，低于肌肉和黄骨髓，T2WI中高信号，低于皮下脂肪，高于黄骨髓；,黄骨髓：T1WI高信号，类似皮下脂肪，T2WI中低信号，低于皮下脂肪；,红黄骨髓MR信号特点红骨髓：T1WI中或稍高信号，低于肌肉和,4,骨髓转换,红骨髓与黄骨髓分布随年龄不同而不同；,由婴儿期全红骨髓到成人型黄骨髓（25岁）发生生理性转换，即骨髓转换；,从外周骨向中轴骨对称性转换；,骨髓转换红骨髓与黄骨髓分布随年龄不同而不同；,5,骨髓转换与成人骨髓分布,Kricun ME.Skeletal Radiol 1985;14:1019,骨髓转换与成人骨髓分布Kricun ME.Skeletal,6,中轴骨骨髓转换（颅骨+椎体+骨盆）,中轴骨骨髓转换（颅骨+椎体+骨盆）,7,颅骨骨髓转换,颅骨20岁以前即可完成转化；,颅骨骨髓转换3种信号分类及分布特点：,10岁以内，骨髓呈低信号，主要反映了红骨髓的特点；,20-30岁，额骨与枕骨均匀一致的高信号，顶骨片状低信号；,大于30岁，整个颅骨均匀高信号，主要反映了黄骨髓的特点；,颅骨骨髓转换颅骨20岁以前即可完成转化；,8,11岁 42岁 70岁,11岁 42岁 70岁,9,脊椎骨髓信号,I型：均匀低信号，椎体中央带状高信号，20岁以前；,II型：局灶周边型，终板及椎角高信号；,IIIa型：模糊弥漫点状不均匀型，弥漫点片状高信号，40岁以后；,IIIb型：清晰弥漫片状不均匀型，40岁以后；,Ricci C,etal.Radiology,1990.,脊椎骨髓信号I型：均匀低信号，椎体中央带状高信号，20岁以前,10,椎体骨髓信号分型,Ricci C,etal.Radiology,1990.,I型,II型,IIIa型,IIIb型,椎体骨髓信号分型 Ricci C,etal.Radiol,11,14岁 I型,14岁 I型,12,40岁，II型,40岁，II型,13,54岁，IIIa型,54岁，IIIa型,14,60岁，IIIb型,60岁，IIIb型,15,A：I型，男，17岁,骨髓信号较均匀一致；,B：II型，男，19岁,椎体中央带状花结样高信号；,C：III型，男，45岁,椎体边缘、角部、后部斑点、斑片状高信号；,D：VI型，男，70岁，椎体内弥漫分布不均匀大小不一斑点、斑片状高信号。,国内分型,欧阳凤晴,等.临床放射学杂志，2002,A：I型，男，17岁,骨髓信号较均匀一致；,16,骨盆骨髓信号,1岁以内，均匀低信号，高于肌肉，低于脂肪；,2-10岁髋臼及髂前上棘出现高信号，其余部位均匀低信号，随年龄增大，高信号增多，信号不均匀；,2岁后髋臼高信号不随年龄改变而改变；,骨盆骨髓信号,17,骨盆骨髓信号分型,I型：髋臼处片状高信号，见于30岁以前；,II型：除I型信号外，在其他部位出现片状高信号，多见于40岁以后；,骨盆骨髓信号分型,18,骨盆骨髓信号,Ricci C,etal.Radiology,1990.,I型,II型,骨盆骨髓信号 Ricci C,etal.Radiolog,19,15岁,25岁,15岁 25岁,20,40岁,60岁,40岁,21,外周骨髓转化（肱骨+股骨）,外周骨髓转化（肱骨+股骨）,22,肱骨骨髓信号,生后3个月开始红骨髓转换黄骨髓,顺序如下：,近侧骨骺-骨干-远侧干骺端-近侧干骺端；,近端骨骺和骨干-6岁前完成；,近侧干骺端6-10岁红黄骨髓混杂不均匀中等信号；,15岁后除近侧干骺端存在红骨髓外，其他部位均转换完成；,成人1/3近侧骨端完全由黄骨髓构成；,肱骨骨髓信号生后3个月开始红骨髓转换黄骨髓,顺序如下：,23,肱骨骨髓转化,小于10岁,10-20岁,大于20岁,肱骨骨髓转化小于10岁10-20岁大于20岁,24,30岁,50岁,13岁,30岁50岁13岁,25,股骨骨髓信号,骨骺和大转子（6-12月）-骨干-远侧干骺端-近侧干骺端；,10岁骨干骨髓转换完成；,远侧干骺端10-20岁信号升高明显；,20岁以后股骨转换完成，除近侧干骺端残留红骨髓表现为中等信号外，其余均为高信号；,股骨骨髓信号骨骺和大转子（6-12月）-骨干-远侧干骺端-近,26,股骨骨髓转化,股骨骨髓转化,27,6岁,6岁,28,20岁,40岁,60岁,20岁40岁60岁,29,小 结,MR是目前唯一能区别红骨髓和黄骨髓的影像学检查方法；,骨髓转换与年龄有关系，不同年龄红黄骨髓分布存在差异；,红骨髓转变为黄骨髓从外周向中轴骨对称性转换；,认识骨髓信号特点及随年龄转换的规律是识别病变的基础；,小 结MR是目前唯一能区别红骨髓和黄骨髓的影像学检查方法；,30,骨髓病变MR,骨髓病变MR,31,骨髓逆转换,骨髓逆转换,32,骨髓逆转换（黄骨髓-红骨髓）,女，21岁，贫血,骨髓逆转换（黄骨髓-红骨髓）女，21岁，贫血,33,35岁，男性，地中海贫血，骨髓逆转换,Laurie A,etal.AJNR Am J Neuroradiol 23:248254,2002,35岁，男性，地中海贫血，骨髓逆转换Laurie A,eta,34,骨髓浸润,骨髓浸润,35,51岁，女性，乳腺癌骨转移瘤,51岁，女性，乳腺癌骨转移瘤,36,50岁，男，肺癌骨转移,50岁，男，肺癌骨转移,37,多发性骨髓瘤,Fig.1 Multiple myeloma:multifocal,and diffuse patterns.,A Coronal T1-weighted spin echo,(SE)MR image shows innumerable tiny foci of low signal intensity on a background of fatty marrow.,b Coronal T1-weighted SE MR image of a different patient shows diffuse,symmetric,low signal intensity in the marrow of proximal and mid femurs,mimicking the appearance of red marrow.,c Coronal fat suppressed T2weighted,MR image of the left hip of the same patient as in b reveals diffuse,markedly high signal throughout the marrow,indicating the presence of marrow disease rather than red marrow,Skeletal Radiol(2007)36:10171027,多发性骨髓瘤Fig.1 Multiple myeloma:,38,淋巴瘤,Fig.2 Multifocal Hodgkin disease,with false-negative blind marrow biopsy from the posterior ilium.Axial a,b T1-weighted and c,d corresponding fat-suppressed T2-weighted SE MR images show focal tumor deposits in marrow of the right iliac wing and left acetabulum(long arrows).Note linear biopsy tract(short arrows)within normal-appearing marrow of the right posterior ilium;this biopsy yielded a false-negative,marrow assessment,Skeletal Radiol(2007)36:10171027,淋巴瘤Fig.2 Multifocal Hodgkin d,39,淋巴瘤,淋巴瘤,40,骨髓水肿,骨髓水肿,41,男性，12岁，骨髓炎,男性，12岁，骨髓炎,42,骨挫伤,骨挫伤,43,骨髓缺失,骨髓缺失,44,70岁，女性，骨质疏松骨髓脂肪变,70岁，女性，骨质疏松骨髓脂肪变,45,肿瘤放疗后骨髓改变,Fig.7 Post-radiation marrow,changes in the thoracic spine.,Sagittal T1-weighted SE MR,image shows diffuse fatty marrow throughout the portion of the thoracic spine that had been included within the radiation therapy port;the most cephalad and caudad vertebrae included in the port are indicated by asterisks.Therapy was directed,at spinal metastases(the largest located within the T8,vertebral body),Skeletal Radiol(2007)36:10171027,肿瘤放疗后骨髓改变Fig.7 Post-radiation,46,女性，50岁，宫颈癌放疗后,女性，50岁，宫颈癌放疗后,47,骨髓纤维化,骨髓纤维化,48,骨髓梗死,骨髓梗死,49,男性，56岁，激素应用3月后，右侧股骨下端及胫骨上端骨梗死。,男性，56岁，激素应用3月后，右侧股骨下端及胫骨上端骨梗死。,50,骨梗死,Fig.9 Marrow infarcts after,chemotherapy for acute lymphoblastic leukemia.,a Sagittal T1-weighted SE MR image shows typical serpiginous rims with low signal intensity surrounding regions of fatty marrow in distal femur and proximal tibia.,b Sagittal fatsuppressed T2-weighted MR image shows a double-line sign(arrow),consisting of an inner band of high signal intensity and an outer band of dark signal,Skeletal Radiol(2007)36:10171027,骨梗死Fig.9 Marrow infarcts afte,51,小 结,骨髓逆转换-慢性贫血，地中海贫血；,骨髓浸润-转移瘤，骨髓瘤，白血病；,骨髓缺失-骨髓纤维化，化疗放疗后改变；,骨髓缺血和梗死-骨梗死，股骨头坏死,骨髓水肿-骨髓炎，骨挫伤，隐匿性骨折；,小 结骨髓逆转换-慢性贫血，地中海贫血；,52,谢 谢,53,