Lesions with Fluid-Fluid Levels 含液-液平面的病变

22 11月

1.What is the incidence of this finding?

液-液平面的发现几率有多大?

2. Are you able to arrive at a specific diagnosis based on your observation?

是否能够通过这一征象得到最终诊断结果?

3. What is the most likely cause of the fluid-fluid level?

液-液平面最主要的原因是什么?

4. Is this finding compatible with benignity?

这一征象是否提示为良性病变?

Lesions with Fluid-Fluid Levels 含液-液平面的病变

Lesions with Fluid-Fluid Levels 含液-液平面的病变


Lesions with Fluid-Fluid Levels

含液-液平面的病变

  1. Nearly 3% of bone or soft tissue tumors show a fluid-fluid level.

    接近3%的骨或软组织肿瘤可见液-液平面。

2. No, fluid-fluid levels in bone or soft tissue tumors cannot be considered diagnostic of any particular tumor.

不能。骨或软组织肿瘤内的液-液平面征象并不能用于诊断某一特定肿瘤。

3. Prior hemorrhage within the lesion.

病变内早期出血

4. No, because it may be seen in osteosarcoma (classic and telangiectatic), malignant fibrous histiocytoma, and soft tissue sarcomas.

不能。液-液平面也可以建议骨肉瘤(传统型或毛细血管扩张型)、恶性纤维组织细胞瘤、及软组织肉瘤。

References

Keenan S, Bui-Mansfield LT: Musculoskeletal lesions with fluid-fluid level: A pictorial essay. J Comput Assist Tomogr30:517–524, 2006.

Van Dyck P, Banhoenacker FM, Vogel J, et al:Prevalence, extension and characteristics of fluidfluid levels in bone and soft tissue tumors. Eur Radiol16:2644–2651, 2006.

Cross-Reference

Musculoskeletal Imaging: THE REQUISITES, 3rd ed, p 418.

Comment

A fluid-fluidlevel is one of the most common observations during the evaluation of tumors ofthe bone and soft tissues. This may be noted on either computed tomography ormagnetic resonance imaging. These levels become apparent when a fluidcollection containing substances of different density is allowed to settle, andwhen the plane of imaging is perpendicular to the fluid level. Frequently butnot always, fluid-fluid levels indicate prior hemorrhage. This finding can beobserved in a wide variety of lesions:osseous and soft tissue masses, neoplastic or non-neoplastic lesions, malignantor benign neoplasms, and primary or metastatic malignancies. It may also beseen in tumoral calcinosis, with calcium-fluid levels. When a fluid-fluid levelis detected, in conjunction with clinical history, the differential diagnosisfor a lesion can often be limited to a few choices. Fluid-fluid levels werefirst reported to occur in aneurysmal bone cysts. However, fluid-fluid levelshave more recently also been associated with malignant neoplasms such astelangiectatic osteosarcoma, conventional osteosarcoma, and malignant fibroushistiocytoma of bone; benign neoplasms such as chondroblastoma, giant celltumor of bone, fibrous dysplasia, simple bone cyst, and osteoblastoma; and softtissue tumors including soft tissue hemangioma, synovial sarcomas, and othersoft tissue sarcomas.

液平面是骨与软组织肿瘤常见征象之一,可见于CTMRI。当液体内含有不同密度的物质并沉降,且成像平面与液平面相垂直时即可显示液液平面。液液平面常提示早期出血,但不仅限于此,这一征象可以见于很多疾病当中,包括骨与软组织的肿块、肿瘤或非肿瘤病变、良性或者恶性肿瘤、恶性或者良性肿瘤、原发肿瘤或者转移瘤。肿瘤内发生钙化、钙质沉着时,也可见钙液平面。

当观察到液液平面时,结合病史,可以缩小鉴别诊断的范围。液-液平面最早报道于动脉瘤样骨囊肿(ABC),然而这一征象也见于恶性肿瘤如毛细血管扩张性骨肉瘤、传统骨肉瘤、骨恶性纤维组织细胞瘤,良性肿瘤如成软骨细胞瘤、骨巨细胞瘤、骨纤维结构不良、单纯骨囊肿、成骨细胞瘤,以及软组织肿瘤包括血管瘤、滑膜肉瘤、及其他软组织肿瘤。

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