Distribution and imaging features of pelvic bone destruction in children

Q4 Medicine

中华小儿外科杂志 Pub Date : 2020-01-15 DOI:10.3760/CMA.J.ISSN.0253-3006.2020.01.016

Xiangshui Sun, Xiongdong Wang

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Abstract

Objective To explore the distribution and imaging manifestations of pelvic bone destruction to improve the diagnostic level of pelvic bone destruction in children. Methods Retrospective analysis was performed for the clinical data of 41 children with pelvic bone destruction confirmed by surgically and pathological at two children's hospitals from August 2008 to September 2018. In conjunctions with postoperative pathological diagnosis, the distribution and imaging findings were analyzed. Results There were 29 boys and 12 girls with an average age of treatment (6.2±2.2)(11 moths to 13 years). The initial symptoms included hip pain (n=16), limping (n=11), hip pain with low fever (n=9) and unintentional radiographic findings (n=4). The locations of lesion were iliac bone (n=33), ischium (n=4), pubis (n=2), sacrum (n=1) and iliac & sacrum (n=1). The average duration of disease was (12.6±4.3)(2-30) days. Routine DR films of anterior/posterior pelvis (n=41), spiral CT scan with three-dimensional reconstruction (n=36) and sagittal, axial and coronal MRI scans (n=26) were performed. The major imaging findings were osteolytic bone destruction (n=27), mixed bone destruction (n=10), inflated bone destruction (n=4), distinct lesion boundary (n=21) and blurred boundary (n=20). There were associated soft tissue mass or swelling of different sizes (n=12) and periosteal reaction (n=7). Histopathological diagnoses included Langerhans cell histiocytosis (n=16), iliac metastasis of neuroblastoma (n=9), osteomyelitis (n=5), Ewing's sarcoma (n=3), tuberculosis (n=2), giant cell tumor of bone (n=1), chondroma (n=1), bone cyst (n=1), peripheral primitive neuroectodermal tumor (n=1), fibrous dysplasia of bone (n=1) and non-Hawking's lymphoma (n=1). Conclusions For various types of pelvic bone destruction in children, bony destruction is located predominantly in iliac wing. Langerhans cell histiocytosis and neuroblastoma are the most common iliac tumors in childhood. Imaging manifestations have certain characteristics of iliac osteolytic destruction. However, the specificity of imaging manifestations is not high so that histopathology is required for making a definite diagnosis. Key words: Ilium; Destruction of bone; Imaging diagnosis; Child

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儿童骨盆骨破坏的分布及影像学特征

目的探讨儿童盆腔骨破坏的分布及影像学表现，提高对盆腔骨破坏的诊断水平。方法回顾性分析两所儿童医院2008年8月至2018年9月经手术和病理证实的41例盆腔骨破坏患儿的临床资料。结合术后病理诊断，分析其分布及影像学表现。结果男29例，女12例，平均治疗年龄(6.2±2.2)岁(11个月~ 13岁)。最初症状包括髋关节疼痛(n=16)、跛行(n=11)、伴有低烧的髋关节疼痛(n=9)和无意的影像学表现(n=4)。病变部位为髂骨(33例)、坐骨(4例)、耻骨(2例)、骶骨(1例)、髂骶骨(1例)。平均病程为(12.6±4.3)(2 ~ 30)d。常规骨盆前后位DR片(n=41)，螺旋CT三维重建扫描(n=36)， MRI矢状、轴状、冠状面扫描(n=26)。主要影像学表现为溶骨性骨破坏(n=27)、混合性骨破坏(n=10)、膨大性骨破坏(n=4)、病灶边界清晰(n=21)、边界模糊(n=20)。伴有不同大小的软组织肿块或肿胀(n=12)和骨膜反应(n=7)。组织病理学诊断包括朗格汉斯细胞组织细胞增生症(16例)、神经母细胞瘤髂转移(9例)、骨髓炎(5例)、尤文氏肉瘤(3例)、肺结核(2例)、骨巨细胞瘤(1例)、软骨瘤(1例)、骨囊肿(1例)、外周原始神经外胚层肿瘤(1例)、骨纤维结构不良(1例)、非霍金淋巴瘤(1例)。结论在各种类型的儿童骨盆骨破坏中，骨破坏主要发生在髂翼。朗格汉斯细胞组织细胞增生症和神经母细胞瘤是儿童最常见的髂肿瘤。髂溶骨破坏的影像学表现具有一定的特点。然而，影像学表现的特异性不高，需要组织病理学才能明确诊断。关键词:髂骨;破坏骨骼;影像诊断;孩子

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来源期刊

中华小儿外科杂志 Medicine-Pediatrics, Perinatology and Child Health

CiteScore

0.40

自引率

0.00%

发文量

8707

期刊介绍： Chinese Journal of Pediatric Surgery is an academic journal sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. The journal was founded in 1980 and is included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences) and CSCD Chinese Science Citation Database Source Journal (including extended version). It is one of the national key academic journals under the supervision of the China Association for Science and Technology. Chinese Journal of Pediatric Surgery enjoys a high reputation and influence in the academic community. The articles published in this journal have a high academic level and practical value, providing readers with a large number of practical cases and industry information, and have received widespread attention and citations from readers.