来源：熊猫放射

病史

56岁男性，左髋部疼痛。（A 56-year-old man with left hip pain.）

影像学表现

X线片(a)显示股骨颈见一圆形硬化性病变。Radiograph (a) shows a rounded sclerotic lesion in the femoral neck.

病变在MRI T1WI(b)和 T2WI(c)上都表现为均匀一致的低信号，周围无骨髓水肿。The lesion is uniformly low signal on both the T1- (b) and T2-weighted (c) MR images. No perilesional marrow edema is seen.

鉴别诊断(前3位)

• 骨岛 Bone island

• 硬化性骨转移瘤(前列腺) Sclerotic metastasis (prostate)

• 低级别骨肉瘤 Low grade osteosarcoma

讨论

骨岛十分常见，在T1WI、T2WI上呈低信号，鉴别诊断时需首先考虑。Bone islands are low signal on T1 and T2 and very common; therefore, they should be highest on the differential list.

但硬化性骨转移瘤也可有类似的表现。如果男性患者 PSA<10ng/mL，发生前列腺癌骨转移的可能性不大；但在前列腺切除术后，任何可检测到的血浆PSA水平均提示存在转移瘤的可能。However, sclerotic metastases can have a similar appearance. In a man with a PSA <10 ng/mL, prostate cancer bone metastasis is highly unlikely. However, following prostatectomy, any detectable serum PSA level implies the presence of metastatic disease.

低级别骨肉瘤通常都比这个病灶要大，并有疼痛，而骨岛是无症状的。Low grade osteosarcomas are typically larger than this and can be painful, whereas bone islands are asymptomatic.

诊断

• 骨岛

  Bone island

又一例

要点

• 当致密(皮质)骨发生在髓腔内就会形成骨岛，因此骨岛是错构瘤而非真性肿瘤。A bone island occurs when compact (cortical) bone develops in the medullary cavity, thus they are hamartomas and not true tumors.

• 通常表现为邻近关节、椭圆形、边缘有轻微毛刺，并与宿主骨长轴平行，病变周围无水肿表现。They typically occur next to joints, are oval, have a slightly spiculated border, parallel the long axis of the host bone, and should not have perilesional edema.

• 无疼痛症状，需与成骨性骨转移瘤鉴别。They should be painless and need to be distinguished from osteoblastic metastases.

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