Gayer G, Yellin A, Apter S, Rozenman Y
Department of Radiology, The Chaim Sheba Medical Centre, Sackler School of Medicine, Tel Aviv University, Tel Hashomer 52621, Israel.
Eur Radiol. 1998;8(2):239-43. doi: 10.1007/s003300050371.
The aim of our study was to define the appearance of methyl methacrylate grafts replacing resected sternum and ribs on CT and MRI and how the sternal graft may mimic an abnormally sclerotic sternum on CT images. We reviewed the CT scans of nine patients who had undergone chest wall resection (eight with malignant and one with benign disease) and reconstruction with a composite of methyl methacrylate and Marlex mesh graft. One of them had an MRI study as well. The size, shape and CT attenuation were assessed on mediastinal and bone window settings. The sternal graft was seen on mediastinal and even better on bone windows as an abnormally wide, irregularly shaped structure, somewhat denser than the normal sternum. The chest wall prosthesis replacing resected ribs was seen as a continuous dense structure and of similar attenuation as that of the sternal graft. On MRI the prosthesis appeared as a well-defined structure with no signal. Reconstruction of the chest wall with methyl methacrylate appears on CT as a diffusely dense sclerotic bone lesion not unlike a malignant lesion. The possibility of a graft has to be included in the differential diagnosis in these cases.
我们研究的目的是确定在CT和MRI上甲基丙烯酸甲酯移植物替代切除的胸骨和肋骨的表现，以及胸骨移植物在CT图像上如何模仿异常硬化的胸骨。我们回顾了9例接受胸壁切除（8例恶性疾病，1例良性疾病）并用甲基丙烯酸甲酯和Marlex网片移植物复合物重建的患者的CT扫描。其中1例也进行了MRI检查。在纵隔和骨窗设置下评估移植物的大小、形状和CT衰减。在纵隔窗上可看到胸骨移植物，在骨窗上看得更清楚，表现为异常宽阔、形状不规则的结构，比正常胸骨稍致密。替代切除肋骨的胸壁假体表现为连续的致密结构，衰减与胸骨移植物相似。在MRI上，假体表现为边界清晰的无信号结构。用甲基丙烯酸甲酯重建胸壁在CT上表现为弥漫性致密的硬化性骨病变，与恶性病变无异。在这些病例的鉴别诊断中必须考虑移植物的可能性。
