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成人膝部肿瘤的影像学评估

Authors
Shahla Modarresi, MD
Cecilia Matilda Jude, MD
Section Editor
Robert H Shmerling, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH
Translators
梅炯, 主任医师

引言

膝关节是人体最大也是最复杂的关节之一。其内衬有滑膜，由位于股骨髁、内侧和外侧胫骨平台之间的2个屈戍关节，以及位于髌骨与股骨远端前方的滑车沟之间的1个滑动关节组成(图 1) [1]。

本专题将讨论疑诊或临床明显的膝部或膝部周围肿瘤的放射影像学评估，包括X线平片、磁共振成像(magnetic resonance imaging, MRI)和计算机断层扫描(computed tomography, CT)特征，以及特定关节内肿瘤样病变的放射影像学表现。

病史和体格检查(是在选择影像学检查前提出鉴别诊断所必需的资料)、评价骨和关节疼痛所采用的影像学检查的一般概述，以及采用影像学检查评估儿童和青少年膝部疼痛的相关内容将在别处讨论。 (参见“成人膝关节痛的一般评估”和“关节疼痛的影像学评估”和“对年轻运动员急性膝关节疼痛或损伤的认识”和“年轻运动员慢性膝痛或膝损伤的处理方法”)

膝部肿块病变的影像学检查方法

X线平片、CT和MRI是诊断关节内和关节旁骨性或软组织肿块病变的主要影像学检查方法[2]。下面简要讨论这几种检查方法各自在膝部肿瘤和瘤样病变评估中的作用。

X线平片 — X线平片是检测和评估肿瘤的一般特征的首选初始方法，但X线平片检测软组织肿瘤的准确性有限。X线平片是评估正常骨与具有骨肿瘤特征的肿瘤之间的边界(过渡区)的最有价值方法。过渡区的放射影像学特征对于鉴别良恶性骨病变非常重要。X线平片也可以显示骨皮质破坏的范围、骨膜反应、基质钙化及病理性骨折。某些影像学表现，结合患者的年龄，对于某些特定肿瘤具有很大的提示意义。

                          

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-18.
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