AbstractObjective To investigate the clinical, imaging, and pathological features of osseous cystic echinococcosis(CE) and osseous alveolar echinococcosis(AE) to enhance diagnostic accuracy and differential diagnosis capabilities. Methods A retrospective analysis of 58 pathologically confirmed osseous echinococcosis cases was conducted, collecting demographic, clinical, imaging, and histopathological data. Results Of 58 patients, 49 (84.48%) had osseous CE and 9 (15.52%) had osseous AE. Both types predominantly affected farmers/herdsmen. The spine was the most commonly affected site (CE: 70.41%, AE:44.44%), and multi-site involvement was common (CE: 71.43%, AE: 88.89%). Osseous CE showed multilocular cystic hypodense lesions (57.97%) on CT and "grape-cluster-like" lesions with long T1/T2 signals (90.16%), with ring-like enhancement of the cyst wall and septa sometimes on MRI. Osseous AE presented heterogeneous density with calcifications(50%) on CT, and MRI showed mixed signals, with calcifications and fibrous components showing low signals on T2WI. Histopathologically, osseous CE specimens contained "laminated membrane"–like material (68.35%); powder-stained plate-like stratum corneum was observed under the microscope (100%). Osseous AE displayed necrotic debris (70.00%); honeycomb-like microcysts were seen within the necrotic background (100%). Conclusion Osseous CE and AE share overlapping Clinical features, but exhibit differences in CT/MRI and pathological characteristics. Compared to osseous CE, osseous AE demonstrated broader site distribution, more frequent multisystem involvement, and a more aggressive clinical course with shorter disease duration prior to diagnosis. Mastering the key features is essential for accurate diagnosis.
Yimingjiang et al. (Sun,) studied this question.