Pediatric Radiology ( IF 2.1 ) Pub Date : 2022-08-09 , DOI: 10.1007/s00247-022-05396-6
Ricardo Restrepo 1 , David Zahrah 2 , Liset Pelaez 3 , H Thomas Temple 4 , James W Murakami 5
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Aneurysmal bone cyst (ABC) is a benign but locally aggressive lesion that predominantly affects children and young adults. ABC, which accounts for approximately 70% of the cases, is now recognized to be a true neoplasm, whereas ABC-like changes associated to other bone neoplasms (also referred in the literature as secondary ABC) accounts for the remaining 30%. The solid variant of ABC is also considered a true neoplasm but is rare. ABC can involve any bone in the body, and although it has a metaphyseal preference, it can involve any part of a bone and soft tissues. As with any bone tumor, the initial evaluation of ABCs should be done with radiographs followed by magnetic resonance imaging or less frequently computed tomography for further characterization. The imaging appearance of ABC is variable; however, a lytic and expansile lesion with fluid-fluid levels is the most common presentation. The main differential diagnosis of an ABC in the pediatric population is unicameral bone cyst (UBC) and telangiectatic osteosarcoma, therefore a biopsy is recommended before treatment. The therapeutic options of ABC range from curettage with or without adjuncts such as phenol, liquid nitrogen, argon laser and bone grafting or bone substitutes to more recently employed alternatives such as image-guided sclerotherapy with various sclerosing agents and monoclonal antibodies (e.g., Denosumab).
中文翻译:
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动脉瘤性骨囊肿的最新进展:病理生理学、组织学、影像学和治疗
动脉瘤性骨囊肿 (ABC) 是一种良性但局部侵袭性病变,主要影响儿童和年轻人。占约 70% 病例的 ABC 现在被认为是真正的肿瘤,而与其他骨肿瘤相关的 ABC 样变化(在文献中也称为继发性 ABC)占其余 30%。ABC的实体变体也被认为是真正的肿瘤,但很少见。ABC 可以涉及身体的任何骨骼,虽然它具有干骺端偏好,但它可以涉及骨骼和软组织的任何部分。与任何骨肿瘤一样,ABCs 的初步评估应通过 X 光片进行,然后进行磁共振成像或不太常见的计算机断层扫描以进一步表征。ABC的成像外观是多变的;然而,具有液-液水平的溶解性和扩张性病变是最常见的表现。儿童人群中 ABC 的主要鉴别诊断是单房骨囊肿 (UBC) 和毛细血管扩张性骨肉瘤,因此建议在治疗前进行活检。ABC 的治疗选择范围从刮除加或不加辅助剂(如苯酚、液氮、氩激光和骨移植或骨替代物)到最近采用的替代方法,如使用各种硬化剂和单克隆抗体(如 Denosumab)的图像引导硬化疗法.