The Use of MRI in Diagnosis of Histiocytosis X: A Case Report

磁振造影在診斷組織細胞症的使用：一個病例報告

陳志程(Jyh-Ching Chen) ； 蔡仁明(Jen-Ming Tsai)

《中華放射線醫學雜誌》 22卷1期 (1997/02) Pp. 43-46

摘要

我們報告一位46歲女性組織細胞症患者(histiocytosis X)。該病患在臨床上沒有完全表現出組織細胞症典型的三個症狀（尿崩症，凸眼，和蝕骨病兆）。反之，病患只是表現持續頭痛和長期的沮喪。侵犯的部位包括頭顱，腰椎，骨盆和股骨。同時下視丘也被侵犯。X光發現在頭顱有多處蝕骨病灶和左側腸骨一處蝕骨病灶，第四腰椎和右上股骨的病灶沒被發現，它們是在Tc99 MDP骨掃描中發現的，患者未接受電腦斷層掃描檢查。頭部磁振造影也查出顱骨內多處病灶：包含右顯骨，右上頂骨，和左下頂骨。下視丘的病灶則呈現圓形之腫瘤。該病症乃經由組織切片而診斷。組織細胞症的臨床表徵經常不典型而且X光片可能查不出骨病灶。因此，電腦斷層攝影和磁振造影是必要的，磁振造影對病兆的偵測及建立診斷方面更有幫助。

關鍵字

組織細胞症 ； 顱骨，磁振造影

並列摘要

A 46-year-old female with histiocytosis X was reported. The classic clinical triad of histiocytosis X was not manifested on the patient. Instead, the patient complained of a persistent headache and long-term depression. The disease involved the cranium, lumbar vertebrae, pelvis, femur and the hypothalamus as well. Plain radiographs of the skull and pelvis depicted multiple osteolytic lesions over the cranium with an osteolytic lesion in left iliac crest. The lesions in the fourth lumbar vertebra and the right upper femur were overlooked on plain radiographs. They were depicted on the Tc99 MDP bone scan. The cranial Computed Tomography (CT) scan was not performed. Magnetic Resonance images (MRI) of the head revealed multiple intraosseous masses over the right temporal bone, right superior parietal bone, and the left inferior parietal bone. Another hypothalamic lesion was also depicted by MRI as well which manifested as a well-defined, rounded mass. The diagnosis was established by an excisional biopsy of the lesion over the right temporal bone. Clinical presentations of histiocytosis X may be atypical and plain radiographs might overlook the bony lesions. Therefore, both CT scan and MRI are necessary in establishing the diagnosis. For diagnosis of histioctyosis X, CT scan may be useful and MRI may be more helpful in demonstrating the lesions and establishing the diagnosis.

並列關鍵字

Histiocytosis ； skull, MR