Medical Imaging Analysis Report

I. Imaging Findings

Based on the provided CT and MRI images, a relatively well-defined lesion showing bone destruction and expansion is observed in the occipital bone region, with relatively clear margins. On CT, the lesion appears lytic, and mild sclerotic changes can be seen in some areas. On MRI, the lesion shows iso- or hypointensity on T1-weighted images and heterogeneous or slightly hyperintense signals on T2-weighted images. Contrast enhancement reveals varying degrees of enhancement, indicating a rich blood supply. Part of the lesion protrudes into the cranial cavity but still maintains a certain boundary with the surrounding brain tissue. No significant compression or cerebral edema is observed in the parenchyma, and the basal cisterns, brainstem, and nearby soft tissues remain relatively intact in shape.

II. Potential Diagnoses

Combining the patient’s gender (male), age (14 years), and the occipital location of the lesion with local pain as the main symptom, possible differential diagnoses include:

• Osteoblastoma: Commonly seen in adolescents; the lesion can be lytic or mixed, often with relatively clear boundaries. Pathological findings typically show proliferation of osteoid tissue and osteoblasts.
• Aneurysmal Bone Cyst: Often presents as an expansile lytic lesion with a “blow-out” appearance; internal septations or fluid-fluid levels may be visible.
• Giant Cell Tumor: More commonly occurs in the epiphyses of long bones and is relatively rare in the skull. It can present as expansile erosion and requires pathological examination to confirm.
• Intradiploic Meningioma: Can cause localized destruction or proliferation of the skull. On imaging, it may be difficult to distinguish from primary bone lesions.
• Epidermoid/Dermoid Cyst: Common benign cystic lesions of the skull or intracranial space, but typically lack significant bone sclerosis or infiltration, which helps differentiate them from this lesion.
• Eosinophilic Granuloma: Occurs in children, presenting as single or multiple lytic lesions with irregular borders; pathological confirmation is needed to rule it out.

III. Most Likely Final Diagnosis

Combining the patient’s age, clinical symptoms (persistent head and neck pain), imaging characteristics (lytic lesion in the occipital bone with partial sclerotic margins and variable enhancement on MRI), and histological findings demonstrating osteoid formation and osteoblast proliferation, the most likely final diagnosis is occipital osteoblastoma.

IV. Treatment Plan & Rehabilitation Strategy

1. Treatment Strategy:

• Surgical Treatment: For well-defined osteoblastoma lesions with significant symptoms or intracranial compression signs, surgical resection is the primary treatment. Although there is a relatively low risk of local recurrence and malignant transformation, careful postoperative follow-up is advised. Complete resection and periodic dynamic imaging evaluation are suggested.
• Postoperative Monitoring and Follow-up: Regular imaging follow-up (CT or MRI) is recommended to monitor possible recurrence or abnormal remodeling at the resected site. If pathological findings indicate active osteogenesis or potential malignant changes, the follow-up schedule should be intensified.
• Supportive and Symptomatic Treatment: This includes routine postoperative pain management and infection prevention. In cases with smaller lesions or mild symptoms, observation and periodic imaging surveillance may be considered.

2. Rehabilitation and Exercise Prescription:

• Early Rehabilitation (1–2 weeks post-surgery):
  • Focus on rest and basic daily activities, avoiding excessive pressure on the neck and occipital region.
  • Perform simple limb stretching and ankle pump exercises in bed to prevent thrombosis and muscle atrophy.
• Intermediate Rehabilitation (2–6 weeks post-surgery):
  • Gradually increase daily activity level. Light walking is recommended, controlling walking speed and duration to about 10–20 minutes per session, 2–3 times a day.
  • Introduce gentle neck movement exercises, such as slow left-right rotation or forward-backward bending while seated or standing, avoiding large-range twisting.
• Late Rehabilitation (6 weeks post-surgery and onward):
  • After ensuring bone healing and local stability, progressively return to more regular exercise. Start light strength training (with resistance bands or small weights), and continue low-impact aerobic activities like walking or using a stationary bike.
  • Exercise frequency can be maintained at 3–5 times per week. Keep the intensity at a level that does not produce significant pain or fatigue, with each session lasting 20–30 minutes. Depending on recovery, duration can be gradually increased to 30–45 minutes.
  • Pay close attention to how the body responds and monitor the surgical site. Seek medical advice if severe pain or discomfort arises.

Throughout the rehabilitation process, follow the FITT-VP Principle (Frequency, Intensity, Time, Type, Volume, Progression). Progress should be guided by a professional physician or rehabilitation therapist, ensuring bone stability and healing are adequately monitored to prevent complications from premature loading.

Disclaimer

This report is a reference based on the currently available information and does not replace in-person consultations or professional medical advice. If you have further questions or develop new symptoms, please seek timely medical attention and consult with a qualified healthcare professional.