脊柱肿瘤和肿瘤样病变—培训课件.pptVIP

Thank You Fig. Multiple plasmacytomas with cord compression. a Sagittal T1WI (left) andbSTIR (right) MRI of thoracic spine show scattered focal lesions involving vertebral bodies and posterior elements of thoracic spine. Bothc transverse and sagittal (a, left) MRI show cord compression by a focal expansile mass (arrow) at the T10 spinous process. a b c 多发浆细胞瘤 Myeloma of T5-T7 T2WI T1WI T1WI+C T1WI STIR T2WI STIR 转移性骨肿瘤 Secondary Tumor or Metastatic Tumor 临床病理 脊柱转移常见 转移途径主要是血行转移，少数直接蔓延 原发肿瘤常包括：前列腺癌、肾癌、甲状腺癌、乳癌、肺癌和鼻咽癌等。骨肉瘤、尤文瘤和淋巴瘤也可发生骨转移 患者51～60岁最多 转移性骨肿瘤影像表现 X线 溶骨型、成骨型和混合型 CT 能显示局部软组织肿块的范围、大小及邻近脏器的关系 MRI 多数肿瘤T1WI呈低信号，T2WI呈程度不高的高信号 脂肪抑制序列显示更清楚 sclerotic metastases Fracture mass Figure. Sagittal T1-weighted MR image of the lumbosacral spine shows multiple hypointense foci within the sacrum and lumbar vertebrae. These lesions remained hypointense with all of the MR imaging sequences and did not exhibit enhancement. Plain radiography revealed sclerotic metastases. 77-yr F Metastatic breast cancer Fig.A : Sagittal T2-weighted MR image demonstrating involvement of the posterior elements of L-3 (arrow). Fig.B : Axial T1-weighted MR image revealing the L-3 spinous process and lamina infiltrated by tumor, with anterior structures intact (arrow). Fig.c: Bone scan demonstrating numerous additional sites of metastatic disease (ribs, skull, and scapula) in addition to L-3 (arrow). The patient underwent simple posterior decompression. 54-yr M metastatic renal cell carcinoma A B C 肺Ca骨转移 骨外NHL骨转移 脊椎骨髓瘤与转移瘤鉴别： 椎体破坏+软组织肿块倾向骨髓瘤 椎体破坏+广泛性骨质疏松倾向骨髓瘤。 椎体破坏伴椎弓及附件早期破坏倾向转移瘤。 动脉瘤样骨囊肿 Aneurysmal Bone Cyst, ABC 临床病理 原因不明的肿瘤样病变，分原发和继发性 可继发于骨巨细胞瘤、骨母细胞瘤、软骨母细胞瘤和骨肉瘤等 由大小不等的海绵状血池组成，外壁为薄壁囊状骨壳 好发于10～20岁的青少年 脊柱占12-30％，胸椎最常受累；病变位于椎弓及其突起 可行刮除植骨术，还可栓塞治疗和放疗；总的复发率为20-30% 影像表现 X线 脊柱附件骨膨胀性囊状透亮区，薄骨壳 囊内可有骨小梁状分隔或骨嵴 CT 囊状膨胀性骨破坏 软组织肿块、不规则钙化，边缘可有硬化 液-液平面，下部密度高于上部 MRI 检出液-液平面更敏感 液-液平面是本病的重要特点，T2