脊索瘤的影像诊断及临床治疗分析

目的 探讨脊索瘤的影像特点及临床治疗.方法 回顾性分析32例经病理证实的脊索瘤MRI、CT、病理及各种临床治疗手段及相关预后.结果 32例中,颅底19例,颈椎1例;骶尾部12例.23例行MRI检查,10例行CT检查,2例行DSA检查.MRI:肿块边界清、分叶,均有不同程度骨质破坏;T_2WI高信号为主,T_1WI低信号为主,增强后18例轻中度强化, 1例明显强化.CT:6例散点状钙化,等低密度为主7例,高密度为主2例,1例混杂密度,3例行增强扫描,呈轻度强化.病理示大量黏液样基质成分及其中的液滴状细胞为特征,免疫组化CK、Vitmentin、EMA、S-100、Ki-67、PAS等阳性.共30例进行手术,3例无明显残留,6例2次或多次手术,3例X刀定位放疗,2例经皮注射化疗药.结论 脊索瘤的影像特点具有特征性,彻底的手术切除及辅以放化疗是治疗脊索瘤的共识.

Chordoma: Imaging Diagnosis and Clinical Therapy

Objective To investigate imaging findings and clinical therapy of chordoma. Methods Imaging findings, pathology, clinical therapy and related prognosis of 32 patients with chordomas proved by pathology were analyzed retrospectively. Results Among 32 cases,the lesions located at skull base in 19 cases,at crevical vertebrae in one and at lumbar vertebrace in 12. 23,10 and 2 cases underwent MRI, CT and DSA examinations,respectively. MRI imaging showed various degrees of destruction of bone in bouncary shed-ul and sublobe of the tumor,the lesions were high signal intensity on T_2WI and low signal intensity on T_1 WI,after administration of contrast medium, 18 cases presented low or intermediate enhancement and 1 case presented obvious enhancement. CT imaging showed punctate calcification in 6 cases,iso-hypodense in 7 cases,hypodense in 2 cases and mixed density in 1 case,3 cases underwent contrast-enhanced CT scan,the lesions showed slight enhancement. Pathobiology showed a lot of mucoid intercellular tissue, and a large number of the cells which had a vacuolated cytoplasm with hyperchromatic nuclei. Immunohistochemisty showed that CK,Vitmentin,EMA,S-100,Ki- 67,PAS etcetera were positive. 30 cases underwent operations,among them,3 cases were of no obvious residues,6 cases underwent operation twice or more,3 cases underwent X knife radiotherapy and 2 cases underwent chemical therapy after first operation. Conclusion Chordomas are of imaging characteristics. It is a general agreement that complete surgical resection followed by chemotherapy or radiotherapy for chordoma.