脊柱孤立性浆细胞骨髓瘤9例影像学分析

目的分析脊柱孤立性浆细胞骨髓瘤（SPB）的影像学特征。方法对9例经手术及病理证实的脊柱SPB的X线平片、CT、MRI表现进行回顾性分析。结果所有患者均为单发病变，年龄41-68（51．6±6．5）岁，男女比例2：1，1例发生在颈椎、6例发生在胸椎、1例发生在腰椎，1例发生在骶椎。病椎附近疼痛是其共同的首发症状，9例患者尿本一周蛋白均为阴性。X线平片显示单个椎体溶骨性、膨胀性骨质破坏，边界清晰，无骨膜反应。CT显示椎体呈膨胀性、溶骨性破坏，可见残存较厚的骨嵴。周围软组织肿块平扫与周围肌肉密度一致，增强后明显强化；MRI显示病变椎体信号不均匀，相邻椎间隙信号不变。增强扫描明显强化。MRI可以更加清晰地显示软组织肿块、椎管受累及脊髓受压。结论X线平片可发现SPB病灶，并作基本定位；CT和MRI能更清楚地显示病灶。MRI能够清楚地显示肿瘤的骨髓浸润及其与周围组织的关系，显示脊髓受压，并有助于与其他单发脊柱肿瘤鉴别。

Analysis on imaging presentation of solitary plasmacytoma of bone in 9 cases

Objective To explore the imaging presentation of solitary plasmacytoma of bone （ SPB）. Methods Clinical and ima- ging data of 9 patients with SPB confirmed by surgery or histopathological examination were collected and analyzed retrospectively. Results All the patients had single lesion, located in the vertebrae, including in cervical vertebrae in 1, in thoracic vertebrae in 6, in lumbar vertebrae in 1 and in sacral vertebrae in 1 case （s）. The male-to-female ratio was 2 to 1. The age of the patients ranged from 41 to 68 （ mean = 51.6 ± 6.5 ） years. Urine Benee-Jones protein was negative in all the patients. The common symp- tom was pain in the surrounding regions. The imaging features of X-ray appeared as solitary bone-lytic destruction, with well-defined margin. No periosteal reactions were seen on X-ray film. CT showed solitary vertebral expansile and osteolytic destruction, with thicker visible residual ridge. CT scan showed soft tissue mass. The surrounding soft tissue mass was of the same density as muscles around, but it was obviously strengthened under the condition of enhanced scan. MRI clearly showed the soft tissue mass, spinal in- volvement and spinal cord compression. The bone marrow and surrounding soft tissue invasion were displayed dearly by MRI, but the signals of lesions were various. Conclusion SPB are well defined by X-ray. X-ray is also used in basic positioning. CT and MRI can depict the morphological features and the extent of regions dearly. MRI can show the relationship between bone marrow in- flitration with the surrounding tissue dearly, provide a lot of information for diagnosis of plasmacytoma.