The clinical significance of the sequestrum sign in limb bone imaging

ZHANG Yuan; CHEN Hai-song; FENG Wei-hua; ZHOU Rui-zhi

doi:10.12117/jccmi.2018.12.012

Journal of China Clinic Medical Imaging ›› 2018, Vol. 29 ›› Issue (12) : 884-888. DOI: 10.12117/jccmi.2018.12.012

ZHANG Yuan, CHEN Hai-song, FENG Wei-hua, ZHOU Rui-zhi

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Abstract

Objective: To study the differences of the occurrence rate of “sequestrum” sign in different diseases of extremity. Methods: Patients with limb bone diseases and bone destructive lesions in our hospital from 2008 to 2016 were retrospectively analyzed. Two hundred and fifty-three patients with 13 types of diseases that proved by pathology or clinical follow-up were included in the observation. CT examination was performed in all cases, radiography in 163 cases, MRI in 144 cases, and all the three kinds of examination was performed in 66 cases. CT images were used to observe the occurrence of the “sequestrum” sign and to calculate the occurrence rate of the sign. χ2 test was used to perform statistical analysis. Results: “Sequestrum” sign appeared in 92.3%(12/13) of the disease types and in 43.1%(109/253) of all the cases. But occurrence rate of “sequestrum” sign differed in different types of the disease, osteomyelitis 52.9%(27/51), skeletal tuberculosis 70.0%(7/10), metastatic carcinoma 47.1%(48/102), fibrous dysplasia 32.1%(9/28), and giant cell tumor of bone 22.2%(6/27). The occurrence rate was the highest in bone tuberculosis(χ2=11.532, P<0.05), followed by osteomyelitis and bone metastases. Other types with less cases also showed “sequestrum” sign, including 3 cases of Langerhans cell histiocytosis(3/8), 1 case of primary lymphoma of bone(1/6), 2 cases of malignant fibrous tumors(2/5), 3 cases of aneurysmal bone cyst(3/5), 1 case of osteofibrous dysplasia(1/8), 1 case of angiosarcoma of bone(1/1), and 1 case of fibrosarcoma of bone(1/1). The sign was not found in the only one case of primitive neuroectodermal tumor(PNET)(0/1). Conclusion: “Sequestrum” sign can be seen in vast majority of limb bone disease of benign and malignant bone destructive lesions, but it is seen in skeletal tuberculosis most commonly, followed by osteomyelitis and bone metastases. We should combine this sign with other signs to make qualitative diagnosis and avoid misdiagnosis.

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Bone diseases / Tomography, X-ray computed / Magnetic resonance imaging

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ZHANG Yuan, CHEN Hai-song, FENG Wei-hua, ZHOU Rui-zhi. The clinical significance of the sequestrum sign in limb bone imaging[J]. Journal of China Clinic Medical Imaging. 2018, 29(12): 884-888 https://doi.org/10.12117/jccmi.2018.12.012

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