Zhang Lihua, Jiang Liang, Yuan Huishu, Liu Zhongjun, Liu Xiaoguang
Department of Radiology, Peking University Third Hospital, Beijing, PR China.
Department of Orthopaedics, Peking University Third Hospital, Beijing, PR China.
J Craniovertebr Junction Spine. 2017 Jul-Sep;8(3):199-204. doi: 10.4103/jcvjs.JCVJS_21_16.
Langerhans cell histiocytosis (LCH) may affect atlas and axis, and there were very few published cases describing a characteristic of LCH of atlantoaxial.
The objective of the study is to investigate the image manifestations of atlantoaxial LCH to improve the in-depth comprehension on it.
A retrospective study was done of computed tomography (CT) and magnetic resonance imaging in atlas and axis and prognosis was analyzed.
The study included 41 patients (average age 12.9 years and median age 8 years) diagnosed with LCH, with 75.6% under 15 years old. Eighty-four lesions of LCH were identified including 47 in the atlas and 37 in the axis. The osteolytic bone destructions in the atlas and axis were characterized, 22% accompanied by sclerotic margins. Thirteen patients had a compression fracture, 11 in the lateral mass of the atlas and 2 in the C2 vertebral body. Sixteen and three patients had atlantoaxial malalignment and dislocation, respectively. On T2-weighted images, 68.9% showed iso- or low-signal intensity, 27.6% showed hyperintensity signal, and 3.4% showed heterogeneous signal. On postcontrast images, 81.9% showed significant enhancement, 12.5% showed moderate enhancement, and 6.3% showed mild enhancement. CT reexamination of 14 patients indicated atlantoaxial bone destruction relatively repaired in 12 patients. Thirty-three patients were a follow-up, 81.8% had no significant symptoms and 18.2% with remaining symptoms.
The atlas and axis were affected by LCH, mainly in children. The lateral mass was easily affected and compressed, destruction of the atlas and axis could lead to atlantoaxial joint instability. The prognosis was good in most of the patients.
朗格汉斯细胞组织细胞增多症（LCH）可累及寰椎和枢椎，而关于寰枢椎LCH特征的病例报道极少。
研究寰枢椎LCH的影像表现，以提高对其的深入认识。
对寰椎和枢椎的计算机断层扫描（CT）及磁共振成像进行回顾性研究，并分析预后情况。
该研究纳入41例确诊为LCH的患者（平均年龄12.9岁，中位年龄8岁），其中75.6%患者年龄在15岁以下。共发现84处LCH病灶，其中47处在寰椎，37处在枢椎。寰椎和枢椎的溶骨性骨质破坏具有特征性，22%伴有硬化边缘。13例患者发生压缩性骨折，11例在寰椎侧块，2例在C2椎体。分别有16例和3例患者存在寰枢椎排列不齐和脱位。在T2加权图像上，68.9%表现为等信号或低信号强度，27.6%表现为高信号强度，3.4%表现为信号不均匀。增强后图像上，81.9%表现为明显强化，12.5%表现为中度强化，6.3%表现为轻度强化。14例患者的CT复查显示，12例患者的寰枢椎骨质破坏相对修复。33例患者进行了随访，81.8%无明显症状，18.2%仍有症状。
寰椎和枢椎可受LCH累及，主要见于儿童。侧块易受累及受压，寰椎和枢椎的破坏可导致寰枢关节不稳。大多数患者预后良好。
