骨骼病变磨玻璃密度的X线与CT对比研究
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摘要
目的：探讨骨骼病变磨玻璃密度的影像学特点，分析磨玻璃密度影中不同种类骨骼病变所占的比例；通过分析磨玻璃密度病变的种类、部位、内部结构、CT值、边界及周围骨质改变来判断磨玻璃密度影征象在骨骼疾病诊断中的价值。
方法：回顾性分析作者所在医院2003年7月～2010年7月经手术病理证实的2386例骨骼病变，选择X线平片上具有磨玻璃密度同时又具有CT作对比的病例为研究对象。设定以X线平片上具有磨玻璃密度的为磨玻璃密度组（ground-glass opacity，GGO），以CT上具有磨玻璃密度的为真性磨玻璃密度组（true ground-glass opacity，tGGO）；以X线平片上具有磨玻璃密度而CT上不具有磨玻璃密度的为假阳性磨玻璃密度组（falseground-glass opacity，fGGO）。分析X线平片上和CT上磨玻璃密度出现的差异。
根据磨玻璃密度的均匀性又将tGGO又分为纯磨玻璃密度（pureground-glass opacity， pGGO）和混合磨玻璃密度(mixed ground-glassopacity，mGGO)，对pGGO组和mGGO组诊断纤维结构不良和其他疾病的差异进行卡方检验。根据mGGO所占病变体积百分比将mGGO分为mGGO所占病变体积≥50%者为mGGO-A组，＜50%者为mGGO-B组。分析mGGO-A和mGGO-B两组中病种的构成及在鉴别诊断中的价值。分析不同部位发生磨玻璃密度的特点。测量各组病种的中位CT及CT值范围。观察fGGO病变周围的硬化边和厚度、骨膜反应和骨痂的发生率，分析fGGO的形成原因。
结果：2386例骨肿瘤及肿瘤样病变中，X线平片上具有磨玻璃密度的病变246例，在CT上185例具有tGGO，即X线平片上所显示的GGO有近1/4在CT扫描时并非真正的GGO。
185例tGGO组病变区在CT上均包含有磨玻璃密度区，磨玻璃密度区的CT值在140～600Hu之间。依次是纤维结构不良132例（71.4%）、内生软骨瘤13例（7%）、骨肉瘤9例（4.9%）、软骨母细胞瘤7例（3.8%）、软骨肉瘤5例（2.7%）、骨母细胞瘤3例（1.6%）、慢性骨髓炎2例（1%）、软骨粘液样纤维瘤2例（1%）及其他病变共10例（5.4%）。
185例tGGO中有52为pGGO，其中依次是纤维结构不良49例（94.2%）、内生软骨瘤2例（3.9%）和软骨肉瘤1例（1.9%）；133例mGGO组病变依次是纤维结构不良83例（62.4%）、内生软骨瘤11例（8.3%）、骨肉瘤9例（6.8%）、软骨母细胞瘤7例（5.3%）、软骨肉瘤4例（3%）、骨母细胞瘤3例（2.3%）及其他病变共16例（12%）。经卡方检验pGGO组中纤维结构不良的发生率大于mGGO组。
95例mGGO-A组病变依次是纤维结构不良74例（77.9%）、骨肉瘤6例（6.3%）、骨母细胞瘤3例（3.2%）、内生软骨瘤2例（2.1%）、软骨肉瘤2例（2.1%）及其他病变8例（8.4%）；38例mGGO-B组病变依次是内生软骨瘤9例（23.7%）、纤维结构不良9例（23.7%）、软骨母细胞瘤7例（18.4%）、骨肉瘤3例（7.9%）、软骨肉瘤2例（5.2%）、骨囊肿2例（5.2%）及其他病变6例（15.8%）。经卡方检验mGGO-A中纤维结构不良的发生率大于mGGO-B组。
185例tGGO病变共218个病灶，其中股骨100个病灶，分别是pGGO29个病灶和mGGO71个病灶。股骨100个病灶中纤维结构不良为67例。而颅面骨12个病灶分别是pGGO11个病灶和mGGO1个病灶，12个病灶中纤维结构不良11例，全部为pGGO。余106个病灶分布其他各部位。颅面骨发生pGGO的几率高，经卡方检验具有tGGO时颅面骨组发生纤维结构不良的比率高于其他部位组。
61例fGGO病变区在CT上均无磨玻璃密度影，其内CT值为14.4～112Hu。其常见病变依次是纤维结构不良25例（41%）、骨囊肿9例（14.8%）、动脉瘤样骨囊肿4例（6.6%）、骨内腱鞘囊肿4例（6.6%）、朗格汉斯细胞组织细胞增生症4例（6.6%）、非骨化性纤维瘤3例（4.9%）、骨巨细胞瘤3例（4.9%）、甲状旁腺机能亢进症（泛发性纤维囊性骨炎）3例（4.9%），其他病变共5例（8.2%）。61例fGGO病变中，病变周围具有硬化边的46例（75.4%），具有骨膜反应的7例（11.5%），具有骨痂的4例（6.6%），病变内残留骨嵴1例,3例（4.9%）无硬化边、骨膜反应及骨痂。
结论：在骨骼病变中，X线平片上呈现磨玻璃密度的病变，其中约1/4在CT上不呈磨玻璃密度。GGO主要见于纤维结构不良，亦可见于其他病变。CT上病变区呈现弥漫性的GGO时诊断纤维结构不良更为可靠，尤其当病变位于颅面骨时。CT上呈现磨玻璃密度影的病变区CT值在140～600Hu。X线平片上GGO的形成除与病变区自身存在的多量骨化和钙化有关外，还与病变区周围的硬化、骨膜反应等重叠有关，亦有局部病变在整体骨质密度减低衬托下形成的皮髓质模糊不清的假象。在诊断和鉴别诊断时应结合其他征象和临床表现综合分析。
Objectives: To evaluate the imaging features of the ground-glass opacityof bone lesions and to observe the constituent ratio of the GGO in differentbone lesions. To assess the value of GGO in the diagnosis of bone diseases byanalyzing the internal structure, CT value, margin and distribution of thelesions.
Methods: A retrospective analysis of2386cases with bone lesionsproved surgically or pathologically from July2003to July2010in ourhospital was performed. Of these cases, those with ground-glass opacity(GGO) on X-ray film and meanwhile having CT scan as a contrast werechosen as objects of study. Lesions with ground glass density shown on X-raywere described as the group of ground-glass opacity(GGO), which wascategorized into Group tGGO (true ground-glass opacity, GGO shown on CT)and Group fGGO (false ground-glass opacity, GGO presented not on CT onlyon X-ray).
On the basis of the lesion features, those with tGGO weresub-categorized into two groups: pGGO (pure ground-glass opacity) andmGGO (mixed ground-glass opacity). The differences of fibrous dysplasia ofbone and other diseases between group fGGO and tGGO were compared usingchi-squared analysis. According to the proportion of GGO area within asolitary lesion, GGO lesions were further divided into two groups: groupmGGO-A was those with the GGO area not smaller than50%; groupmGGO-B was those with the GGO area smaller than50%. The constituentratio of different diseases in group mGGO-A and group mGGO-B, distributionof lesions with GGO and their values in differential diagnosis were analyzed.CT value of GGO area in different diseases were measured. The incidence andthickness of sclerotic rim around lesions with fGGO, periosteal reaction and callus was observed. Meanwhile, the cause for fGGO was analyzed.
Results: Of the2386patients with bone lesions,246contained GGO onX-ray,185contained tGGO on CT.
185cases of tGGO lesions，the CT value ranged from140to600Hu inthe tGGO area. The most common lesion in this group was fibrousdysplasia(132cases,71.4%）, followed by enchondroma (13,7%),osteosarcoma (9,4.9%), chondroblastoma (7,3.8%), osteosarcoma (5,2.7%),osteoblastoma (3,1.6%), chronic osteomyelitis (2,1%), Chondromyxoidfibroma (2,1%), and other diseases (10,5.4%).
52cases with pGGO in decending order were fibrous dysplasia（49,94.2%）, enchondroma (2,3.9%), osteosarcoma (1,1.9%).133cases withmGGO were fibrous dysplasia（83,62.4%）, enchondroma (11,8.3%),osteosarcoma (9,6.8%), chondroblastoma (7,5.3%), chondrosarcoma (4,3%),osteoblastoma (3,2.3%), and other diseases (16,12%). The data was assessedby chi-square and it showed that the incidence of fibrous dysplasia in grouppGGO was higher than that in group mGGO.
95cases in group mGGO-A were fibrous dysplasia （74,77.9%),osteosarcoma (6,6.3%), osteoblastoma (3,3.2%), enchondroma (2,2.1%), andchrondrosarcoma (2,2.1%) and other diseases (8,8.4%).38cases in groupmGGO-B ranked the top three were enchondroma (9.23.7%), fibrousdysplasia(9,23.7%) and chondroblastoma (7,18.4%), followed byosteosarcoma (3,7.9%), chondrosarcoma (2,5.2%), bone cyst (2,5.2%) andother diseases (6,15.8%). Chi-square statistics indicated that the incidenceof fibrous dysplasia in group mGGO-A was higher than that in groupmGGO-B.
Among185cases of lesions with tGGO,218foci appeared. The mostcommon location of lesions was the femur with100focuses, including29withpGGO and71with mGGO. Of the100foci,67were fibrous dysplasia. Thenumber of lesions that occurred in craniofacial bone was12, including11withpGGO and1with mGGO. Of the12cases,11cases were fibrous dysplasia, allwith pGGO. The rest of106foci located in other bones. The incidence of pGGO in craniofacial bone was higher. Chi-square assessment displayed theconstituent ratio of fibrous dysplasia with pGGO in craniofacial bone washigher than in other locations.
None of the61cases with fGGO showed GGO image on CT, with the CTvalue ranged from14.4to112Hu. The most common lesions in this groupwere fibrous dysplasia in25cases，followed by solitary bone cyst in9,aneurismal bone cyst in4, intraosseous ganglion cyst in4, langerhans cellhistiocytosis in4, nonossifying fibroma in3, giant cell tumor of bone in3,hyperparathyroidism in3, and other diseases in5. Of the61cases,46(75.4%)had sclerotic rim,7(11.5%) had periosteal reaction,4(6.6%) had callus,1hadresidue bone trabecula in the lesion, and3(4.9%) showed no featuresmentioned above.
Conclusion: In skeletal lesions, GGO presented on X-ray filmapproximately1/4were not shown on CT. GGO mainly present in fibrousdysplasia, and also show in other lesions. Fibrous dysplasia with GGO hassome characteristic manifestation on CT and it was more reliable to bediagnosed with diffuse GGO in the lesion, especially of cranial bones. GGOwas shown on CT when CT value of the legion ranged from140to600Hu.Besides the large amounts of ossification and calcification in the lesions itself,the factors responsible for GGO on X-ray might be overlapping image causedby annular sclerotic rim around the lesion, periosteal reaction, and obscurecontrastive attenuation of cortex and medullary which occurs in the situationof whole bone density decrease. Thus the differential diagnosis should becombined with other signs and clinical features.
方法：回顾性分析作者所在医院2003年7月～2010年7月经手术病理证实的2386例骨骼病变，选择X线平片上具有磨玻璃密度同时又具有CT作对比的病例为研究对象。设定以X线平片上具有磨玻璃密度的为磨玻璃密度组（ground-glass opacity，GGO），以CT上具有磨玻璃密度的为真性磨玻璃密度组（true ground-glass opacity，tGGO）；以X线平片上具有磨玻璃密度而CT上不具有磨玻璃密度的为假阳性磨玻璃密度组（falseground-glass opacity，fGGO）。分析X线平片上和CT上磨玻璃密度出现的差异。
根据磨玻璃密度的均匀性又将tGGO又分为纯磨玻璃密度（pureground-glass opacity， pGGO）和混合磨玻璃密度(mixed ground-glassopacity，mGGO)，对pGGO组和mGGO组诊断纤维结构不良和其他疾病的差异进行卡方检验。根据mGGO所占病变体积百分比将mGGO分为mGGO所占病变体积≥50%者为mGGO-A组，＜50%者为mGGO-B组。分析mGGO-A和mGGO-B两组中病种的构成及在鉴别诊断中的价值。分析不同部位发生磨玻璃密度的特点。测量各组病种的中位CT及CT值范围。观察fGGO病变周围的硬化边和厚度、骨膜反应和骨痂的发生率，分析fGGO的形成原因。
结果：2386例骨肿瘤及肿瘤样病变中，X线平片上具有磨玻璃密度的病变246例，在CT上185例具有tGGO，即X线平片上所显示的GGO有近1/4在CT扫描时并非真正的GGO。
185例tGGO组病变区在CT上均包含有磨玻璃密度区，磨玻璃密度区的CT值在140～600Hu之间。依次是纤维结构不良132例（71.4%）、内生软骨瘤13例（7%）、骨肉瘤9例（4.9%）、软骨母细胞瘤7例（3.8%）、软骨肉瘤5例（2.7%）、骨母细胞瘤3例（1.6%）、慢性骨髓炎2例（1%）、软骨粘液样纤维瘤2例（1%）及其他病变共10例（5.4%）。
185例tGGO中有52为pGGO，其中依次是纤维结构不良49例（94.2%）、内生软骨瘤2例（3.9%）和软骨肉瘤1例（1.9%）；133例mGGO组病变依次是纤维结构不良83例（62.4%）、内生软骨瘤11例（8.3%）、骨肉瘤9例（6.8%）、软骨母细胞瘤7例（5.3%）、软骨肉瘤4例（3%）、骨母细胞瘤3例（2.3%）及其他病变共16例（12%）。经卡方检验pGGO组中纤维结构不良的发生率大于mGGO组。
95例mGGO-A组病变依次是纤维结构不良74例（77.9%）、骨肉瘤6例（6.3%）、骨母细胞瘤3例（3.2%）、内生软骨瘤2例（2.1%）、软骨肉瘤2例（2.1%）及其他病变8例（8.4%）；38例mGGO-B组病变依次是内生软骨瘤9例（23.7%）、纤维结构不良9例（23.7%）、软骨母细胞瘤7例（18.4%）、骨肉瘤3例（7.9%）、软骨肉瘤2例（5.2%）、骨囊肿2例（5.2%）及其他病变6例（15.8%）。经卡方检验mGGO-A中纤维结构不良的发生率大于mGGO-B组。
185例tGGO病变共218个病灶，其中股骨100个病灶，分别是pGGO29个病灶和mGGO71个病灶。股骨100个病灶中纤维结构不良为67例。而颅面骨12个病灶分别是pGGO11个病灶和mGGO1个病灶，12个病灶中纤维结构不良11例，全部为pGGO。余106个病灶分布其他各部位。颅面骨发生pGGO的几率高，经卡方检验具有tGGO时颅面骨组发生纤维结构不良的比率高于其他部位组。
61例fGGO病变区在CT上均无磨玻璃密度影，其内CT值为14.4～112Hu。其常见病变依次是纤维结构不良25例（41%）、骨囊肿9例（14.8%）、动脉瘤样骨囊肿4例（6.6%）、骨内腱鞘囊肿4例（6.6%）、朗格汉斯细胞组织细胞增生症4例（6.6%）、非骨化性纤维瘤3例（4.9%）、骨巨细胞瘤3例（4.9%）、甲状旁腺机能亢进症（泛发性纤维囊性骨炎）3例（4.9%），其他病变共5例（8.2%）。61例fGGO病变中，病变周围具有硬化边的46例（75.4%），具有骨膜反应的7例（11.5%），具有骨痂的4例（6.6%），病变内残留骨嵴1例,3例（4.9%）无硬化边、骨膜反应及骨痂。
结论：在骨骼病变中，X线平片上呈现磨玻璃密度的病变，其中约1/4在CT上不呈磨玻璃密度。GGO主要见于纤维结构不良，亦可见于其他病变。CT上病变区呈现弥漫性的GGO时诊断纤维结构不良更为可靠，尤其当病变位于颅面骨时。CT上呈现磨玻璃密度影的病变区CT值在140～600Hu。X线平片上GGO的形成除与病变区自身存在的多量骨化和钙化有关外，还与病变区周围的硬化、骨膜反应等重叠有关，亦有局部病变在整体骨质密度减低衬托下形成的皮髓质模糊不清的假象。在诊断和鉴别诊断时应结合其他征象和临床表现综合分析。
Objectives: To evaluate the imaging features of the ground-glass opacityof bone lesions and to observe the constituent ratio of the GGO in differentbone lesions. To assess the value of GGO in the diagnosis of bone diseases byanalyzing the internal structure, CT value, margin and distribution of thelesions.
Methods: A retrospective analysis of2386cases with bone lesionsproved surgically or pathologically from July2003to July2010in ourhospital was performed. Of these cases, those with ground-glass opacity(GGO) on X-ray film and meanwhile having CT scan as a contrast werechosen as objects of study. Lesions with ground glass density shown on X-raywere described as the group of ground-glass opacity(GGO), which wascategorized into Group tGGO (true ground-glass opacity, GGO shown on CT)and Group fGGO (false ground-glass opacity, GGO presented not on CT onlyon X-ray).
On the basis of the lesion features, those with tGGO weresub-categorized into two groups: pGGO (pure ground-glass opacity) andmGGO (mixed ground-glass opacity). The differences of fibrous dysplasia ofbone and other diseases between group fGGO and tGGO were compared usingchi-squared analysis. According to the proportion of GGO area within asolitary lesion, GGO lesions were further divided into two groups: groupmGGO-A was those with the GGO area not smaller than50%; groupmGGO-B was those with the GGO area smaller than50%. The constituentratio of different diseases in group mGGO-A and group mGGO-B, distributionof lesions with GGO and their values in differential diagnosis were analyzed.CT value of GGO area in different diseases were measured. The incidence andthickness of sclerotic rim around lesions with fGGO, periosteal reaction and callus was observed. Meanwhile, the cause for fGGO was analyzed.
Results: Of the2386patients with bone lesions,246contained GGO onX-ray,185contained tGGO on CT.
185cases of tGGO lesions，the CT value ranged from140to600Hu inthe tGGO area. The most common lesion in this group was fibrousdysplasia(132cases,71.4%）, followed by enchondroma (13,7%),osteosarcoma (9,4.9%), chondroblastoma (7,3.8%), osteosarcoma (5,2.7%),osteoblastoma (3,1.6%), chronic osteomyelitis (2,1%), Chondromyxoidfibroma (2,1%), and other diseases (10,5.4%).
52cases with pGGO in decending order were fibrous dysplasia（49,94.2%）, enchondroma (2,3.9%), osteosarcoma (1,1.9%).133cases withmGGO were fibrous dysplasia（83,62.4%）, enchondroma (11,8.3%),osteosarcoma (9,6.8%), chondroblastoma (7,5.3%), chondrosarcoma (4,3%),osteoblastoma (3,2.3%), and other diseases (16,12%). The data was assessedby chi-square and it showed that the incidence of fibrous dysplasia in grouppGGO was higher than that in group mGGO.
95cases in group mGGO-A were fibrous dysplasia （74,77.9%),osteosarcoma (6,6.3%), osteoblastoma (3,3.2%), enchondroma (2,2.1%), andchrondrosarcoma (2,2.1%) and other diseases (8,8.4%).38cases in groupmGGO-B ranked the top three were enchondroma (9.23.7%), fibrousdysplasia(9,23.7%) and chondroblastoma (7,18.4%), followed byosteosarcoma (3,7.9%), chondrosarcoma (2,5.2%), bone cyst (2,5.2%) andother diseases (6,15.8%). Chi-square statistics indicated that the incidenceof fibrous dysplasia in group mGGO-A was higher than that in groupmGGO-B.
Among185cases of lesions with tGGO,218foci appeared. The mostcommon location of lesions was the femur with100focuses, including29withpGGO and71with mGGO. Of the100foci,67were fibrous dysplasia. Thenumber of lesions that occurred in craniofacial bone was12, including11withpGGO and1with mGGO. Of the12cases,11cases were fibrous dysplasia, allwith pGGO. The rest of106foci located in other bones. The incidence of pGGO in craniofacial bone was higher. Chi-square assessment displayed theconstituent ratio of fibrous dysplasia with pGGO in craniofacial bone washigher than in other locations.
None of the61cases with fGGO showed GGO image on CT, with the CTvalue ranged from14.4to112Hu. The most common lesions in this groupwere fibrous dysplasia in25cases，followed by solitary bone cyst in9,aneurismal bone cyst in4, intraosseous ganglion cyst in4, langerhans cellhistiocytosis in4, nonossifying fibroma in3, giant cell tumor of bone in3,hyperparathyroidism in3, and other diseases in5. Of the61cases,46(75.4%)had sclerotic rim,7(11.5%) had periosteal reaction,4(6.6%) had callus,1hadresidue bone trabecula in the lesion, and3(4.9%) showed no featuresmentioned above.
Conclusion: In skeletal lesions, GGO presented on X-ray filmapproximately1/4were not shown on CT. GGO mainly present in fibrousdysplasia, and also show in other lesions. Fibrous dysplasia with GGO hassome characteristic manifestation on CT and it was more reliable to bediagnosed with diffuse GGO in the lesion, especially of cranial bones. GGOwas shown on CT when CT value of the legion ranged from140to600Hu.Besides the large amounts of ossification and calcification in the lesions itself,the factors responsible for GGO on X-ray might be overlapping image causedby annular sclerotic rim around the lesion, periosteal reaction, and obscurecontrastive attenuation of cortex and medullary which occurs in the situationof whole bone density decrease. Thus the differential diagnosis should becombined with other signs and clinical features.
引文
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3. Negar GT, Kennedy DW, Kopstein E. Fibrous dysplasia: a review of thedisease and its manifestations in the temporal bone.Ann Otol RhinolLaryngol Suppl,1982,92:1-5
4. Jee WH, Choi KH, Choe BY, et al. Fibrous dysplasia: MR imagingcharacteristics with radiopathologic correlation. AJR Am J Roentgenol,1996,167(6):1523-1527
5.曹来宾.实用骨关节影像诊断学.济南：山东科学技术出版社.1998:414-420
6.丁建平,王溱,刘翠平.骨纤维异常增殖症.中华放射学杂志,1994,28(10):673-676
7.吴文娟,张英泽.骨与软组织肿瘤.北京：人民卫生出版社,2009:856-890
8.张蓓,周玲.16排螺旋CT在骨纤维结构不良诊断中的应用.医学影像学杂志,2010,20(1):146-147
9.陈海松,徐文坚,柳澄.64层CT对骨巨细胞瘤皂泡征的研究.中国医学影像技术,2008,24(5)731-733
10.刘子君,李瑞宗,刘昌茂,等.骨肿瘤及瘤样病变12404例病理统计分析.中华骨科杂志,1986,6(3):162-169
11.Kransdorf MJ, Moser RP Jr, Gilkey FW. Fibrous dysplasia. RadioGraphics,1990;10:519-537
12.李杰,吕梁.少见部位单发性内生软骨瘤的影像表现.中国临床医学影像杂志,2009,20(6):491-493
13.Bulycheva IV, Semenov LA, Makhson AN, et al. Chondroblastoma. ArkhPatol,2007,69:53
14.Turcotte RE, Kurt AM, Sim FN, et al. Chondroblastoma. Hum Pathol,1993,24(9):944-949
15.周建军,曾蒙苏,严福华,等.软骨母细胞瘤影像学特征及病理基础.临床放射学杂志,2009,28(12):1659-1663
16.武峰,樊建中,王万笔.颌骨骨母细胞瘤X线、MSCT表现与误诊分析（附6例报告）.中国临床医学影像学杂志,2010,21(7):523-525
17.李亦民,丁彦青,徐莉.骨母细胞瘤临床病理学研究.中华骨科杂志,1997,17(12):759
18.徐毅,谷洪,张瑞平.中晚期骨梗死的影像学表现.中国CT和MRI杂志,2006,4(1):46-47
19.何敏聪,曾旭文,梁治平,等.9例骨梗死的影像学分析.暨南大学学报（医学版）,2011,32(2):238-240
20.杜玉清,孔祥泉,刘玉卿.骨梗死的影像学表现及病理基础.临床放射学杂志,2004,23(2):143-146
21.冯素臣,程克斌,程晓光,等.骨梗死的影像学改变及病理表现.中华放射学杂志,2004,38(3):249-252
22.宋英儒.原发性骨髓纤维化腰椎和骨盆的MRI和X线诊断探讨.中华放射学杂志,2002,36(7):633-636
23.Chen WJ, Shih TT, Shih LS, et al. Paget’s disease of the bone: a casereport, J-Formos-Med-Assoc.2001;100(2):37
24.Kiloborn TN, The J, Goodman TR. Paediatric Manifestation of LaugerhansCell Histiocytosis: a Review of the Clinical and Radiological Findings.Clin Radiol,2003,58(4):269-278
25.黄斌,赵时梅.软骨母细胞型骨肉瘤的影像学表现及病理学基础分析.放射学实践,2009,24(4):425-429
26.杨本涛,王振常,刘莎,等.鼻眶部软骨肉瘤的CT和MRI诊断.中华放射学杂志,2006,40(6):572-576
27.刘国清,黄信华,许乙凯.原发性软骨肉瘤的组织病理学与影像学表现的对比研究.临床放射学杂志,2007,26(1):80-82
28.Weber AL, Kaneda T, Scrivani SJ, et al. Cysts, tumors, and nontumorouslesions of the jaw. IN: Som PM, Curtin HD, eds Head and neck imaging4th ed St Luois, Mosby,2003,930
29.钟志伟,张雪松,崔建岭,等.骨纤维异常增值症环形硬化边的影像学分析.临床放射学杂志,2010,29(2):216-219
30.丁建平,李石玲,刘斯润.骨与软组织肿瘤影像诊断学.北京:人民卫生出版社,2009:108
31.王新波.甲状旁腺功能亢进骨改变致误诊9例分析.中国伤残医学,2010,18(1):83
32.Geirnaerdt ML, Hermans J, Biloem JL, et al. Usefulness of radiography indifferentiating enchondroma from Central grade I chondrosarcoma. AJR,1997,169(10):1097-110
1. Lichtenstein L. Polyostotic fibrous dysplasia. Arch Surg,1938;36:874-898
2.宋英儒.原发性骨髓纤维化腰椎和骨盆的MRI和X线诊断探讨.中华放射学杂志,2002,36(7):633-636
3.于洪存,董杰,王中周,等.软骨母细胞瘤临床影像学表现与病理分析.中国临床医学影像杂志,2006,17(3):164-166
4.徐毅,谷洪,张瑞平.中晚期骨梗死的影像学表现.中国CT和MRI杂志,2006,4(1):46-47
5.何敏聪,曾旭文,梁治平,等.9例骨梗死的影像学分析.暨南大学学报（医学版）,2011,32(2):238-240
6.武峰,樊建中,王万笔.颌骨骨母细胞瘤X线、MSCT表现与误诊分析（附6例报告）.中国临床医学影像学杂志,2010,21(7):523-525
7. Grey AB. Skeletal effects of primary hyperparathyroidism. Balliere’s ClinEndocrimol Metab,1997;11:101-116
8.胡永成,黄洪超,李海啸,等.继发性甲状旁腺机能亢进症的骨病损的临床特点（附8例报告）.中国骨肿瘤骨病,2009,8(4):199-202
9. Kransdorf MJ, Moser RP Jr, Gilkey FW. Fibrous dysplasia. RadioGraphics,1990;10:519-537
10.Negar GT, Kennedy DW, Kopstein E. Fibrous dysplasia: a review of thedisease and its manifestations in the temporal bone. Ann Otol RhinolLaryngol Suppl,1982,92:1-5
11.Mirra JM, Gold RH. Fibrous dysplasia. In: Mirra JM, Piero P. Gold RH.Bones tumors.Philadelphia: Lea&Febiger,1989:191-226
12.Kumar R, Madewell JE, Lindell MM, Swischuk LE. Fibrous lesions ofbones. RadioGraphics,1990;10:237-256
13.Jee WH, Choi KH, Choe BY, et al. Fibrous dysplasia: MR imagingcharacteristics with radiopathologic correlation. AJR Am J Roentgenol,1996,167(6):1523-1527
14.Chong VF, Khoo JB, Fan YF. Fibrous dysplasia involving the base of theskull. AJR Am J Roentgenol,2002;178(3):717-720
15.王玉凯.骨肿瘤X线诊断学.北京:人民卫生出版社,1995:289-298
16.曹来宾.实用骨关节影像诊断学.济南:山东科学技术出版社,1998:414-420
17.丁建平,王溱,刘翠平.骨纤维异常增殖症.中华放射学杂志,1994,28(10):673-676
18.杨本涛,汪卫中,王振常等.颞骨骨纤维异常增殖症HRCT研究.临床放射学杂志,2003,22(10):835
19.梁碧玲.骨与关节疾病影像诊断学.北京:人民卫生出版社,
2006.408-409
20.高振华,孟悛非,黄兆民,等.髋周单发局灶性骨纤维异常增值症的影像学诊断.临床放射学杂志,2005,24(11):1002
21.肖永鑫,时维东,孙献勇.颅面部骨纤维异常增值症的CT表现.实用放射学杂志,2009,25(5):640-642
22.李杰,吕梁.脊椎骨纤维异常增殖症的CT诊断.中国临床医学影像杂志,2009,20(5):316-318
23.吴文娟,张英泽.骨与软组织肿瘤.北京:人民卫生出版社,2009:856-894
24.John L. Frodel, Gerry Funk, Jay Boyle. et al. Management of AggressiveMidface and Orbital Fibrous Dysplasia. Arch Facial Plast Surg,2000;2:187-195
25.刘子君,李瑞宗,刘昌茂,等.骨肿瘤及瘤样病变12404例病理统计分析.中华骨科杂志,1986,6(3):162-169
26.Geirnaerdt ML, Hermans J, Biloem JL, et al. Usefulness of radiography indifferentiating enchondroma from Central grade I chondrosarcoma. AJR,1997,169(10):1097-1104
27.李杰,吕梁.少见部位单发性内生软骨瘤的影像表现.中国临床医学影像杂志,2009,20(6):491-493
28.Turcotte RE, Kurt AM, Sim FN, et al. Chondroblastoma. Hum Pathol,1993,24(9):944-949
29.周建军,曾蒙苏,严福华,等.软骨母细胞瘤影像学特征及病理基础.临床放射学杂志,2009,28(12):1659-1663
30.李亦民,丁彦青,徐莉.骨母细胞瘤临床病理学研究.中华骨科杂志,1997,17(12):759
31.杜玉清,孔祥泉,刘玉卿.骨梗死的影像学表现及病理基础.临床放射学杂志,2004,23(2):143-146
32.冯素臣,程克斌,程晓光,等.骨梗死的影像学改变及病理表现.中华放射学杂志,2004,38(3):249-252
33.Chen WJ, Shih TT, Shih LS, et al. Paget’s disease of the bone: a casereport, J-Formos-Med-Assoc.2001;100(2):37
34.黄斌,赵时梅.软骨母细胞型骨肉瘤的影像学表现及病理学基础分析.放射学实践,2009,24(4):425-429
35.杨本涛,王振常,刘莎,等.鼻眶部软骨肉瘤的CT和MRI诊断.中华放射学杂志,2006,40(6):572-576
36.刘国清,黄信华,许乙凯.原发性软骨肉瘤的组织病理学与影像学表现的对比研究.临床放射学杂志,2007,26(1):80-82
37.钟志伟,张雪松,崔建岭,等.骨纤维异常增值症环形硬化边的影像学分析.临床放射学杂志,2010,29(2):216-219
38.Kiloborn TN, The J, Goodman TR. Paediatric Manifestation of LaugerhansCell Histiocytosis: a Review of the Clinical and Radiological Findings.Clin Radiol,2003,58(4):269-278
39.谢元忠,谢丛华.成软骨细胞瘤骨膜反应的影像特点.中国医学影像技术,2008,24(2):264-266
40.吴文娟,张英泽.骨与软组织肿瘤.北京:人民卫生出版社,2009:133-135
41.郝大鹏,徐文坚,王振常,等.软骨肉瘤的CT和MRI诊断.中国医学影像技术,2009,25(1):121-124
42.Murphey MD, Walker EA, Wilson AJ, et al. From the archives of the AFIP:imaging of primary chondrosarcoma:Radiologic-pathologic correlation.Radio Graphics,2003.23(5):1245-1278
43.方挺松,陈卫国,黄信华.骨肉瘤的影像学诊断及其进展.中国医学影像技术,2003,19(12):1748-1750
2. Kumar R, Madewell JE, Lindell MM, Swischuk LE. Fibrous lesions ofbones. Radio Graphics,1990;10:237-256
3. Negar GT, Kennedy DW, Kopstein E. Fibrous dysplasia: a review of thedisease and its manifestations in the temporal bone.Ann Otol RhinolLaryngol Suppl,1982,92:1-5
4. Jee WH, Choi KH, Choe BY, et al. Fibrous dysplasia: MR imagingcharacteristics with radiopathologic correlation. AJR Am J Roentgenol,1996,167(6):1523-1527
5.曹来宾.实用骨关节影像诊断学.济南：山东科学技术出版社.1998:414-420
6.丁建平,王溱,刘翠平.骨纤维异常增殖症.中华放射学杂志,1994,28(10):673-676
7.吴文娟,张英泽.骨与软组织肿瘤.北京：人民卫生出版社,2009:856-890
8.张蓓,周玲.16排螺旋CT在骨纤维结构不良诊断中的应用.医学影像学杂志,2010,20(1):146-147
9.陈海松,徐文坚,柳澄.64层CT对骨巨细胞瘤皂泡征的研究.中国医学影像技术,2008,24(5)731-733
10.刘子君,李瑞宗,刘昌茂,等.骨肿瘤及瘤样病变12404例病理统计分析.中华骨科杂志,1986,6(3):162-169
11.Kransdorf MJ, Moser RP Jr, Gilkey FW. Fibrous dysplasia. RadioGraphics,1990;10:519-537
12.李杰,吕梁.少见部位单发性内生软骨瘤的影像表现.中国临床医学影像杂志,2009,20(6):491-493
13.Bulycheva IV, Semenov LA, Makhson AN, et al. Chondroblastoma. ArkhPatol,2007,69:53
14.Turcotte RE, Kurt AM, Sim FN, et al. Chondroblastoma. Hum Pathol,1993,24(9):944-949
15.周建军,曾蒙苏,严福华,等.软骨母细胞瘤影像学特征及病理基础.临床放射学杂志,2009,28(12):1659-1663
16.武峰,樊建中,王万笔.颌骨骨母细胞瘤X线、MSCT表现与误诊分析（附6例报告）.中国临床医学影像学杂志,2010,21(7):523-525
17.李亦民,丁彦青,徐莉.骨母细胞瘤临床病理学研究.中华骨科杂志,1997,17(12):759
18.徐毅,谷洪,张瑞平.中晚期骨梗死的影像学表现.中国CT和MRI杂志,2006,4(1):46-47
19.何敏聪,曾旭文,梁治平,等.9例骨梗死的影像学分析.暨南大学学报（医学版）,2011,32(2):238-240
20.杜玉清,孔祥泉,刘玉卿.骨梗死的影像学表现及病理基础.临床放射学杂志,2004,23(2):143-146
21.冯素臣,程克斌,程晓光,等.骨梗死的影像学改变及病理表现.中华放射学杂志,2004,38(3):249-252
22.宋英儒.原发性骨髓纤维化腰椎和骨盆的MRI和X线诊断探讨.中华放射学杂志,2002,36(7):633-636
23.Chen WJ, Shih TT, Shih LS, et al. Paget’s disease of the bone: a casereport, J-Formos-Med-Assoc.2001;100(2):37
24.Kiloborn TN, The J, Goodman TR. Paediatric Manifestation of LaugerhansCell Histiocytosis: a Review of the Clinical and Radiological Findings.Clin Radiol,2003,58(4):269-278
25.黄斌,赵时梅.软骨母细胞型骨肉瘤的影像学表现及病理学基础分析.放射学实践,2009,24(4):425-429
26.杨本涛,王振常,刘莎,等.鼻眶部软骨肉瘤的CT和MRI诊断.中华放射学杂志,2006,40(6):572-576
27.刘国清,黄信华,许乙凯.原发性软骨肉瘤的组织病理学与影像学表现的对比研究.临床放射学杂志,2007,26(1):80-82
28.Weber AL, Kaneda T, Scrivani SJ, et al. Cysts, tumors, and nontumorouslesions of the jaw. IN: Som PM, Curtin HD, eds Head and neck imaging4th ed St Luois, Mosby,2003,930
29.钟志伟,张雪松,崔建岭,等.骨纤维异常增值症环形硬化边的影像学分析.临床放射学杂志,2010,29(2):216-219
30.丁建平,李石玲,刘斯润.骨与软组织肿瘤影像诊断学.北京:人民卫生出版社,2009:108
31.王新波.甲状旁腺功能亢进骨改变致误诊9例分析.中国伤残医学,2010,18(1):83
32.Geirnaerdt ML, Hermans J, Biloem JL, et al. Usefulness of radiography indifferentiating enchondroma from Central grade I chondrosarcoma. AJR,1997,169(10):1097-110
1. Lichtenstein L. Polyostotic fibrous dysplasia. Arch Surg,1938;36:874-898
2.宋英儒.原发性骨髓纤维化腰椎和骨盆的MRI和X线诊断探讨.中华放射学杂志,2002,36(7):633-636
3.于洪存,董杰,王中周,等.软骨母细胞瘤临床影像学表现与病理分析.中国临床医学影像杂志,2006,17(3):164-166
4.徐毅,谷洪,张瑞平.中晚期骨梗死的影像学表现.中国CT和MRI杂志,2006,4(1):46-47
5.何敏聪,曾旭文,梁治平,等.9例骨梗死的影像学分析.暨南大学学报（医学版）,2011,32(2):238-240
6.武峰,樊建中,王万笔.颌骨骨母细胞瘤X线、MSCT表现与误诊分析（附6例报告）.中国临床医学影像学杂志,2010,21(7):523-525
7. Grey AB. Skeletal effects of primary hyperparathyroidism. Balliere’s ClinEndocrimol Metab,1997;11:101-116
8.胡永成,黄洪超,李海啸,等.继发性甲状旁腺机能亢进症的骨病损的临床特点（附8例报告）.中国骨肿瘤骨病,2009,8(4):199-202
9. Kransdorf MJ, Moser RP Jr, Gilkey FW. Fibrous dysplasia. RadioGraphics,1990;10:519-537
10.Negar GT, Kennedy DW, Kopstein E. Fibrous dysplasia: a review of thedisease and its manifestations in the temporal bone. Ann Otol RhinolLaryngol Suppl,1982,92:1-5
11.Mirra JM, Gold RH. Fibrous dysplasia. In: Mirra JM, Piero P. Gold RH.Bones tumors.Philadelphia: Lea&Febiger,1989:191-226
12.Kumar R, Madewell JE, Lindell MM, Swischuk LE. Fibrous lesions ofbones. RadioGraphics,1990;10:237-256
13.Jee WH, Choi KH, Choe BY, et al. Fibrous dysplasia: MR imagingcharacteristics with radiopathologic correlation. AJR Am J Roentgenol,1996,167(6):1523-1527
14.Chong VF, Khoo JB, Fan YF. Fibrous dysplasia involving the base of theskull. AJR Am J Roentgenol,2002;178(3):717-720
15.王玉凯.骨肿瘤X线诊断学.北京:人民卫生出版社,1995:289-298
16.曹来宾.实用骨关节影像诊断学.济南:山东科学技术出版社,1998:414-420
17.丁建平,王溱,刘翠平.骨纤维异常增殖症.中华放射学杂志,1994,28(10):673-676
18.杨本涛,汪卫中,王振常等.颞骨骨纤维异常增殖症HRCT研究.临床放射学杂志,2003,22(10):835
19.梁碧玲.骨与关节疾病影像诊断学.北京:人民卫生出版社,
2006.408-409
20.高振华,孟悛非,黄兆民,等.髋周单发局灶性骨纤维异常增值症的影像学诊断.临床放射学杂志,2005,24(11):1002
21.肖永鑫,时维东,孙献勇.颅面部骨纤维异常增值症的CT表现.实用放射学杂志,2009,25(5):640-642
22.李杰,吕梁.脊椎骨纤维异常增殖症的CT诊断.中国临床医学影像杂志,2009,20(5):316-318
23.吴文娟,张英泽.骨与软组织肿瘤.北京:人民卫生出版社,2009:856-894
24.John L. Frodel, Gerry Funk, Jay Boyle. et al. Management of AggressiveMidface and Orbital Fibrous Dysplasia. Arch Facial Plast Surg,2000;2:187-195
25.刘子君,李瑞宗,刘昌茂,等.骨肿瘤及瘤样病变12404例病理统计分析.中华骨科杂志,1986,6(3):162-169
26.Geirnaerdt ML, Hermans J, Biloem JL, et al. Usefulness of radiography indifferentiating enchondroma from Central grade I chondrosarcoma. AJR,1997,169(10):1097-1104
27.李杰,吕梁.少见部位单发性内生软骨瘤的影像表现.中国临床医学影像杂志,2009,20(6):491-493
28.Turcotte RE, Kurt AM, Sim FN, et al. Chondroblastoma. Hum Pathol,1993,24(9):944-949
29.周建军,曾蒙苏,严福华,等.软骨母细胞瘤影像学特征及病理基础.临床放射学杂志,2009,28(12):1659-1663
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