（47页PPT）一例椎体的局灶病变影像表现分析暨影像诊断扩展.pptxVIP

一例椎体的局灶病变影像表现分析暨影像诊断扩展;2016病例交流（18）

（源自同学圈子的病例）;女，62岁。腰痛，以急性腰扭伤住院。;腰椎正侧位：问题在哪？;CT轴位图细看;再看CT矢状重组图;CT矢状重组图;看一看该病例的MRI图;T1WI未加压脂矢状位;T2WI未加压脂矢状位;T2WI加压脂矢状位;T2WI未加压脂

轴位;增强T1WI未加压脂冠状位;增强T1WI未加压脂矢状位;增强T1WI未加压脂轴位;增强T1WI压脂;增强T1WI压脂冠状位;增强T1WI压脂轴位;天津医院主任诊断意见：椎体硬化性血管瘤;小结：本例椎体硬化性血管瘤的影像学表现;再看这例椎体血管瘤：也没有“栅栏征”;T2WI压脂;再看这例硬化性血管瘤;EpithelioidhemangiomaofboneSkeletalRadiol(2001)30:226–229;Fig.4Simpleandmildlyplexvascularstructuresareseenwithinfibroustissue(×90)

Fig.5Athighermagnification,thereismildirregularityintheshapeofthebloodvessels.Mostoftheendothelialcellsareflattened(×250)

Fig.6Thisfielddemonstratesbothvascularchannelsandmoresolidareaswithlessobviousvascularity.Inbothareas,theendothelialcellsaresomewhatprominentwithplumpnuclei.Afewtuftedpapillaryprojectionsareseenatlowerleft(×300);本例以骨硬化为特点的上皮样椎体血管瘤的

影像学表现提示;Wepresentacaseofepithelioidhemangiomaofthespinewithanunusualradiologicalappearancewhichtoourknowledgehasnotpreviouslybeenreported:diffusesclerosisoftheinvolvedvertebralbody.

;扩展一：再分析一下椎体血管瘤与病理的关系

有助于认识血管瘤的影像表现;Fig.1a73-year-oldT1WIshowsanareaofintermediatesignalintensity(arrow)withlinearandverticalareasofverylowsignalintensity(smallarrow)intheposteriorpartofthemiddlevertebralbody.BT2WI，intensityofthelesion(arrow)ismoderatelyincreasedinparisonwithadjacentnormalmarrow.CPhotomicrographofthelesionshowsthin-walled,dilatedvessels(star),adipocytes(arrow)andinterstitialedema(smallarrow).

Therelativeproportionofsurfaceareaoccupiedbythin-walled,dilatedvesselsandinterstitialedemais

equivalenttothatoccupiedbyadipocytes.;Fig.2

T1WIofavertebralbodyofthespinespecimenfroma69-year-oldsubjectshowsaheterogeneousareathatconsistsofhigh(arrow)andintermediatesignalintensity(smallarrow).

BPhotographofthecorrespondingmacroscopic