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目的探讨婴幼儿LCH的典型X线表现及其随访评价临床预后的价值与限度。方法22例经临床、实验室、病理检查确诊的LCH,将其按Lavin分级,Ⅰ级9例,Ⅱ级9例,Ⅲ级4例。全部病例均在首诊与化疗随访中摄颅骨、胸片、四肢长骨X线片,12例行颅脑、胸腹部CT检查。结果单纯骨破坏的有7例,化疗后5例缓解,X线表现为破坏区的骨化与重塑。多系统病变的有15例,化疗后4例缓解;其中肺部间质改变7例,化疗后2例缓解。下丘脑-垂体轴侵犯者1例。结论颅骨破坏的变化能很好反映临床病情预后,而X线肺部间质改变对判断疾病的变化不敏感。单纯骨破坏比多系统侵犯预后好。
Objective To investigate the typical X-ray findings of LCH in infants and young children and the value and limitations of follow-up evaluation of clinical prognosis. Methods Twenty-two cases of LCH diagnosed by clinical, laboratory and pathological examination were classified according to Lavin. There were 9 cases of grade Ⅰ, 9 cases of grade Ⅱ and 4 cases of grade Ⅲ. All cases were taken in the first visit and chemotherapy followed up skull, chest X-ray, limb long bone, 12 cases of brain, chest and abdomen CT examination. Results In 7 cases of simple bone destruction, 5 cases were relieved after chemotherapy, and X-ray showed the ossification and remodeling of the damaged area. Multi-system lesions in 15 cases, 4 cases after chemotherapy to alleviate; of which interstitial lung changes in 7 cases, 2 cases of chemotherapy after remission. Hypothalamus - pituitary shaft invaders in 1 case. Conclusions The changes of skull destruction can well reflect the prognosis of clinical conditions, while the changes of X-ray lung interstitial are not sensitive to the changes of the disease. Simple bone destruction than multi-system invasion of good prognosis.