《柱肿瘤》ppt课件.ppt

脊柱病变的影像学诊断 山东省医学影像学研究所 李传亭 CT脊柱检查 MRI检查脊柱的优势 总体优势： 多参数成像 多方位成像，尤其矢状断层 独特优势： 目前唯一能直接显示脊髓内部的影像检查方法 椎间盘病变 椎间盘及椎体的退变 椎间盘膨出和脱出 从脊柱长轴全面观察以免漏掉其他病变 观察突出椎间盘对脊髓或神经根的压迫程度 脊柱创伤 观察脊髓的受伤程度： 水肿、肿胀、出血、断裂、软化 观察椎体的状况： 有形态改变的骨折 无明显形态改变的小梁骨折 观察椎管的其他改变： 增生、狭窄 椎管肿瘤 髓内肿瘤 髓外硬膜下肿瘤 硬膜外肿瘤 Ependymoma(室管膜瘤) The most common intramedullary spinal neoplasm in adults, 60% , 38.8 , male Cervical cord alone the upper thoracic region. Myxopapillary ependymoma Duration of symptoms was 36.5 months Back or neck pain (67%), sensory deficits (52%), motor weakness (46%), Imaging Characteristics CT X-ray: scoliosis or canal widening with associated vertebral body scalloping, pedicle erosion, or laminar thinning MRI: T1WI iso- or hypointense; T2WI hyperintense the cap sign, a rim of extreme hypointensity (seen at the poles of the tumor on T2WI. cord edema. 3.6 vertebral segments; Cysts are a common , Syringohydromyelia Well contrast-enhanced Astrocytoma (星形细胞瘤) One-third of all spinal cord gliomas； Male； 29 years；thoracic cord (67% ), cervical cord (49%) ；Involvement of the entire spinal cord；rare filum terminale ；rarely exophytic. Pain and sensory deficits ；Motor dysfunction. Young children, with a median duration of 5 months. Pathologic Characteristics Ill-defined diffuse fusiform enlargement. Tumor cysts (eccentric, smaller, and irregular) and syrinxes are common Hypercellularity and the absence of a surrounding capsule Enlarged, irregularly shaped, hyperchromatic nuclei WHO classification Grade I： pilocytic astrocytomas 75% Grade II ：fibrillary type Grade III ：anaplastic astrocytomas 25% Grade IV ：glioblastoma multiforme distinctly uncommon Imaging Characteristics CT 、X-ray：mild scoliosis, widened interpedicular distance, and bone erosion MRI：poorly defined margins ；T1WI iso- to hypointense ； T2WI hyperintense；seven vertebral segments； Cysts；eccen