Bisseret Damien, Kaci Rachid, Lafage-Proust Marie-Hélène, Alison Marianne, Parlier-Cuau Caroline, Laredo Jean-Denis, Bousson Valérie
Service de Radiologie Ostéo-Articulaire, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise-Paré, 75010, Paris, France,
Skeletal Radiol. 2015 Mar;44(3):321-38. doi: 10.1007/s00256-014-1976-5. Epub 2014 Oct 1.
The periosteum covers most bone structures. It has an outer fibrous layer and an inner cambial layer that exhibits osteogenic activity. The periosteum is a dynamic structure that plays a major role in bone modeling and remodeling under normal conditions. In several disorders such as infections, benign and malignant tumors, and systemic diseases, the osteogenic potential of the periosteum is stimulated and new bone is produced. The newly formed bone added onto the surface of the cortex adopts various configurations depending on the modalities and pace of bone production. Our aim here is to describe the anatomy, histology, and physiology of the periosteum and to review the various patterns of periosteal reaction with emphasis on relations between radiological and histopathological findings. A careful evaluation of the periosteal reaction and appearance of the underlying cortex, in combination with the MRI, clinical, and laboratory data, provides valuable information on lesion duration and aggressiveness, thereby assisting in the etiological diagnosis and optimizing patient management. A solid reaction strongly suggests a benign and slow-growing process that gives the bone enough time to wall off the lesion. Single lamellar reactions occur in acute and usually benign diseases. Multilamellar reactions are associated with intermediate aggressiveness and a growth rate close to the limit of the walling-off capabilities of the bone. Spiculated, interrupted, and complex combined reactions carry the worst prognosis, as they occur in the most aggressive and fast-growing diseases: the periosteum attempts to create new bone but is overwhelmed and may be breached.
骨膜覆盖了大多数骨结构。它有一个外层纤维层和一个内层成纤维层，后者具有成骨活性。骨膜是一种动态结构，在正常情况下，它在骨塑形和重塑中起主要作用。在一些疾病中，如感染、良性和恶性肿瘤以及全身性疾病，骨膜的成骨潜能会被激发并产生新骨。添加到皮质表面的新形成的骨会根据骨生成的方式和速度呈现出各种形态。我们的目的是描述骨膜的解剖学、组织学和生理学，并回顾骨膜反应的各种模式，重点是放射学和组织病理学发现之间的关系。仔细评估骨膜反应和下方皮质的外观，结合磁共振成像、临床和实验室数据，可提供有关病变持续时间和侵袭性的有价值信息，从而有助于病因诊断并优化患者管理。坚实的反应强烈提示一个良性且生长缓慢的过程，这使骨有足够的时间将病变包绕起来。单层反应发生于急性且通常为良性的疾病。多层反应与中等侵袭性及接近骨包绕能力极限的生长速度相关。针状、中断状和复杂的联合反应预后最差，因为它们发生于最具侵袭性且生长迅速的疾病中：骨膜试图生成新骨，但不堪重负，可能会被突破。
