胸椎嗜酸性肉芽肿1例及文献复习

目的结合脊柱嗜酸性肉芽肿的影像表现,加强对脊柱椎体破坏性疾病的鉴别诊断能力。方法分析1例胸椎嗜酸性肉芽肿病人的CT及MRI表现,同时就脊柱椎体破坏伴周围软组织影的影像诊断文献予以复习。结果 CT示T7椎体呈楔形,其内可见溶骨性骨质破坏,T6、T8椎体前缘局部皮质不规则,可见骨质破坏;周围软组织呈明显梭形增厚;诸椎间盘信号正常,椎间隙未见变窄。MRI平扫示T7椎体呈楔形,T1WI呈低信号,T2WI呈稍高信号,T2WI抑脂序列呈高信号,周围可见软组织影包绕;T6、T8椎体于T2WI抑脂序列上信号略增高。MRI增强示T7椎体呈均匀强化;周围软组织影呈均匀强化,强化方式与病变椎体一致。手术后病理学检查结果符合骨的朗格汉斯细胞增生症。结论脊柱嗜酸性肉芽肿椎体破坏多位于椎体中部,典型表现为"扁平椎"或"铜板椎",椎间盘不受累,增强扫描椎旁软组织明显强化,信号改变及强化方式与病变椎体一致等影像特点是鉴别诊断的关键。     

MRI STIR技术在诊断脊柱转移瘤中的应用价值

目的: 探讨STIR技术在MRI诊断脊柱转移瘤中的应用价值.材料和方法: 回顾性对照分析42例脊柱转移瘤之常规T1WI、T2WI及STIR序列的表现.结果: 42例共累及196个椎体.71个椎体T1WI呈低信号,T2WI呈高信号,11个椎体T1WI、T2WI均呈低信号,114个椎体T1WI或T2WI呈混杂信号,病灶STIR序列均呈异常高信号.105个椎体形态无明显改变,91个椎体伴有后缘膨隆或压缩性骨折,11例继发椎管狭窄,14例伴椎旁软组织肿块,STIR序列能清晰显示以上所有异常.结论: STIR序列易于发现脊柱转移灶,可较准确地判断肿瘤的侵袭范围及程度,并有助于转移瘤的鉴别诊断.     

脊柱转移瘤MRI诊断(附45例报告)

目的　探讨MRI对脊柱转移瘤的敏感性 ,以提高脊柱转移瘤MRI表现的认识。方法　回顾性分析 45例脊柱转移瘤的MRI表现 ,结合文献进行讨论。结果　 45例中共累及 14 9节椎体 ,累及椎弓根 19例 3 2根 ,棘突及横突 7例 11处。椎体压缩呈盘状 8例 2 1节 ,呈楔状 7例 11节 ,病椎轻度膨胀 4例 ,有软组织肿块 18例 ,硬膜囊、脊髓受压 15例 ,脊髓受侵 2例。病椎信号均匀 2 8例 ,不均匀 17例。T1WI为明显低信号 15例 ,略低信号 2 7例 ,等信号 3例。T2 WI为明显高信号 17例 ,略高信号 2 5例 ,等信号 3例。增强 18例 ,病灶明显强化 11例 ,轻度强化 6例 ,不强化 1例。软组织肿块边缘水肿、受压和受侵脊髓在MRI上均显示阳性。结论　MRI检查脊柱转移瘤的敏感性明显优于CT和X线平片 ,尤其肿瘤浸润椎骨尚属水肿、出血、坏死阶段时。     

骨梗死的X线、CT和MRI诊断

目的探讨骨梗死的影像学表现.材料和方法对10例累及28处骨骼的骨梗死患者行X线、CT及MRI检查,将骨梗死分为早、中、晚期,分析其影像学特征.结果病变主要累及股骨下段和胫骨上段,多双侧发病.骨梗死早、中期X线、CT表现为阴性和局部的骨质疏松及斑点状钙化,MRI表现为病变中心T1WI呈等或稍低信号,T2WI呈等或稍高信号,病灶边缘呈典型的地图样改变.晚期X线及CT呈不规则状、蜿蜒状骨质硬化,MRI T1WI及T2WI均呈低信号.结论MRI检查是诊断早、中期骨梗死最有效的方法,优于X线平片和CT;在晚期,X线平片和CT、MRI均有特征性表现,三者相结合可提高诊断准确率.     

脊柱转移瘤的MRI诊断(附34例分析)

目的：探讨MRI对脊柱转移瘤诊断和鉴别诊断的价值。方法：回顾性分析34例脊柱转移瘤的MRI表现，均有明确原发瘤灶。结果：①6例为单椎体病变，28例为多椎体病变；②在T1WI上34例均呈低信号，在T2WI上26例(76．5％)呈高信号，7例(20．6％)呈等信号，1例(2．9％)呈低信号；③椎体骨质破坏分溶骨型、成骨型、混合型三种类型；④椎旁肿块形成者7例(20．6％)；⑤椎管狭窄者13例(38．2％)；⑥跳跃式分布者20例(59．9％)；⑦34例椎间盘的形态及信号均大致正常。结论：脊柱转移瘤具有特征性的MRI表现，综合分析有助于诊断和鉴别诊断。     

髓外硬膜外肿瘤的MRI诊断 [附20例分析)

目的探讨椎管硬膜外肿瘤的MRI表现特点及鉴别诊断.材料与方法分析20例硬膜外肿瘤的MRI影像资料,结合手术病理讨论各种肿瘤的MRI特点.结果本组转移瘤7例,5例呈等T1和略长T2信号,增强扫描均呈明显增强.2例呈长T1长T2信号,6例伴椎体骨质长T1长T2信号,增强扫描均呈明显增强.5例淋巴瘤中3例T1WI呈等信号,2例为略低信号,1例T2WI为高信号,4例为等信号,1例伴胸4椎体骨质内长T1短T2信号,增强扫描3例呈均匀性增强.黑色素瘤2例呈短T1短T2信号,可广泛侵及硬膜.海绵状血管瘤可与神经源性肿瘤的MRI表现相似.胆脂瘤为不规则形长T1长T2信号,肿物充填于椎管内,对椎体骨质有压迫性破坏.脊膜瘤2例呈等T1等T2信号,呈明显均匀性增强.恶性纤维组织细胞瘤呈长T1长T2信号.骨髓瘤可见椎体及椎管内长T1长T2信号,有明显增强.结论椎管内硬膜外肿瘤种类繁多,但以恶性肿瘤最多,其中以淋巴瘤,转移瘤占大多数.恶性纤维组织细胞瘤,胆脂瘤,有时与淋巴瘤,转移瘤MRI表现相仿.而脊膜瘤,黑色素瘤,神经源性肿瘤也可有相类似的MRI表现.因此诊断中应提高警惕,全面考虑.     

几种影像方法对脊柱转移瘤诊断的比较

目的 :分析 93例脊柱转移瘤的MRI、ECT、SCT、X线平片征象 ,以提高脊柱转移瘤的早期诊断率。方法 :回顾性分析 93例经手术病理或随访证实的脊柱转移瘤的MRI、ECT、SCT、X线平片表现。结果 :93例脊柱转移瘤共发现2 79个椎骨异常、184处椎管受累、12 0处椎旁软组织肿块、12 0处椎体病理性骨折。MRIT1 WI表现为低信号 73 .3 %( 198/2 70 ) ,T2 WI表现为高信号 62 .2 %( 168/2 70 ) ,FS T2 WI表现为高信号 85 .2 %( 2 3 0 /2 70 ) ;ECT检出的 2 61处病灶表现为多处放射性浓聚或单发放射性浓聚 ;CT检出 184处病灶表现为局限性或大片骨质破坏 ;X线平片检出的 92处表现为骨质破坏。结论 :MRI及ECT敏感性高于SCT和X线平片 ,MRI、SCT、X线平片特异性高于ECT ;MRI是诊断脊柱转移瘤一种高敏感性和特异性的方法 ,优于ECT、SCT、X线平片 ;脊柱转移瘤首选ECT并结合X线检查 ,必要时SCT或 /和MRI检查。     

脊索瘤的MRI表现

目的：探讨脊索瘤的MRI表现及其诊断价值。方法：回顾性分析17例经临床病理证实的脊索瘤的MRI表现。结果：颅底脊索瘤8例，骶尾部脊索瘤9例，邻近颅底及椎体骨质均有溶骨性破坏，伴硬膜外及骶前较大软组织肿块。17例中16例信号不均匀，T1WI呈低、等信号，T2WI呈明显高信号，MRI增强扫描后，肿瘤均有轻度或中度不均匀性强化。结论：T2WI显著高信号是脊索瘤的特征性MRI表现，有重要鉴别诊断意义，MRI反映肿瘤的部位、侵犯范围以及显示骨质破坏作用均优于CT。     

脊柱动脉瘤样骨囊肿的CT、MRI诊断

目的：分析脊柱动脉瘤样骨囊肿的CT、MRI表现,提高对该病的CT、MRI诊断和鉴别诊断。方法：回顾性分析经临床病理证实的12例脊柱动脉瘤样骨囊肿的CT、MRI表现。结果：12例脊柱动脉瘤样骨囊肿患者中颈椎3例,胸椎6例,腰椎3例;单独椎体侵犯1例,单发于椎板2例,同时累及椎体及附件者9例。CT表现局限性囊状或膨胀性骨质破坏,边界清晰,内可见分房骨嵴影,4例可见内部多发液一液平面影。MRI示膨胀性溶骨性破坏灶周围可见低信号影包绕,病灶内呈多发分房状改变,T1WI呈不均匀低／等信号;T2WI呈数个大小不等的高／等信号囊腔,10例可见不同信号强度的液一液平面影。增强扫描可见囊腔周缘明显强化,腔内出血和液体无强化。结论：脊柱动脉瘤样骨囊肿CT、MRI表现具有一定的特征性,能够做出正确诊断。     

胸椎孤立性浆细胞瘤1例及文献复习

目的探讨胸椎孤立性浆细胞瘤(SPB)的临床表现、影像特征及鉴别诊断。方法分析1例脊柱SPB病人的CT及MRI表现,并复习相关文献。结果 CT示T10椎体呈楔形,轻度膨胀性、溶骨性骨质破坏,边缘骨硬化,内部见残存骨嵴,未见典型"微脑征"。瘤体均质,未见钙化及肿瘤骨。MRI平扫示病变于T1WI呈低信号,T2WI呈稍高信号,T2WI脂肪抑制序列呈高信号,MRI增强示瘤体呈均匀强化,未见椎旁肿块及脓疡,相邻椎间盘信号无异常。手术病理提示浆细胞来源肿瘤,结合ECT及本周蛋白、血钙及肌酸水平,临床诊断为SPB。结论 SPB好发于椎体前部,溶骨性破坏,瘤体均质,常伴有骨嵴及硬化边。"微脑征"有助于诊断,但敏感性较低。SPB的确诊有赖于影像检查、临床实验室及病理结果的综合分析。     

闭合性肾脏损伤的多层螺旋CT诊断分型探讨

目的总结闭合性肾损伤的多层螺旋CT(MSCT)征象,并评价MSCT分型的临床意义。方法 58例闭合性肾损伤患者于外伤后1 h～4 d内均经腹部常规多层螺旋CT扫描,其中32例又经对比增强CT扫描。所有患者中肾损伤的严重程度、血肿或渗出性病变的累及范围以及邻近脏器伴发性损伤,是由3位经验丰富的放射学医师协同评价的。结果根据肾损伤部位、程度和范围可将其MSCT表现分为下述5型:Ⅰ型,包膜下血肿(8例);Ⅱ型,肾实质局灶性挫伤(16例);Ⅲ型,肾实质挫裂伤伴肾周间隙血肿(19例);Ⅳ型,肾实质粉碎伤伴肾筋膜外血肿(13例);Ⅴ型,肾蒂撕裂伤(2例)。肾损伤的分级愈高,邻近脏器伴发性损伤比例愈大。结论 MSCT能清楚显示肾损伤的部位、范围、严重程度以及邻近脏器伴发性损伤,而MSCT分型能为临床选择治疗方案提供重要依据。     

MRI、CT诊断脊椎转移瘤的比较分析

目的:探讨脊椎转移瘤的MRI及CT征象,以提高脊椎转移瘤的早期诊断率。方法:对138例脊椎转移瘤患者进行MRI与CT检查,比较脊椎转移瘤在MRI和CT上的表现。结果:138例脊椎转移瘤共发现399个椎体异常,237处椎管受累,190处椎旁软组织肿块,178处病理性骨折。MRI表现为T1加权低信号74%(294/399);T2加权表现为高信号62%(249/399);脂肪抑制T2加权表现为高信号86%(344/399)。CT检出273处病灶表现为不同形态的骨质破坏,溶骨型66%(179/273),成骨型24%(65/273),混合型10%(29/273)。结论:MRI的敏感性和特异性高于CT,MRI和CT联合应用可提高脊椎转移瘤诊断的敏感性和准确性。     

Bildgebung extraduraler Raumforderungen

There is a wide variety of spinal extradural tumors. In addition to real neoplasms, degenerative diseases, congenital abnormalities and inflammatory disorders can be causes of extradural masses. Due to the bony boundary of the spinal canal, both benign as well as malignant masses can cause progressive neurological deficits including paraplegia. Most of the spinal tumors are benign (hemangioma of the vertebral body, degenerative diseases). In younger patients congenital abnormalities and primary tumors of the spine have to be considered, whereas in adults the list of differential diagnoses should include secondary malignancies such as metastases and lymphomas as well as metabolic disorders such as osteoporotic vertebral compression fracture and Paget's disease. Cross-sectional imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) of the spine often help to make a specific diagnosis of extradural spinal lesions and represent important tools for tumor staging and preoperative evaluation.     

CT and MRI features of spinal hydatidosis. A report of 8 cases

PURPOSE: Hydatidosis affects the bone in 0.5 to 2% of cases, with 44% of these cases involving the spine. We report 8 cases of vertebral involvement evaluated by CT and/or MRI. Materials and Methods. This retrospective study from January 1996 to August 2000 included seven patients (5 men and 3 women) aged between 28 and 65 years old. The mean age was 45 years old. Five patients underwent CT scan (one by CT-myelography). MRI was available in 4 cases. RESULTS: Imaging showed multicystic bony lesions. Thoracic involvement was present in 4 cases, lumbar involvement in 2 cases, and sacral involvement in 2 cases. The process involved 2 adjacent vertebrae in 4 cases at the thoracic and lumbar levels and the entire sacrum in the other cases. Only one case of vertebral collapse was noted, but extension into the spinal canal was noted in all cases. Other sites of involvement were also noted, especially in adjacent soft tissues, liver and spleen. CONCLUSION: The presence of multicystic vertebral lesions with involvement of adjacent soft tissues and/or distant organs should raise the possibility of spinal hydatidosis in endemic countries.     

脊椎肿瘤30例CT分析

本文回顾性分析了经临床或手术病理证实的脊椎肿瘤３０例。在１８例转移性肿瘤中（共累及２７个脊椎），ＣＴ表现为骨质破坏的占２０／２７，成骨型占４／２７，混合型占３／２７。在溶骨型转移中，２０个转移灶位于椎体后２／３，其中１３个病灶同时亦累及椎弓或附件。伴有脊椎周围软组织肿胀的共１１例，８例为局限性，３例为弥漫性。多发性骨髓瘤和血管瘤往往具有典型的ＣＴ表现。骨母细胞瘤多原发于椎弓和附件，并累及椎体。骨巨     

Vertebral metastases and an equivocal bone scan: value of magnetic resonance imaging.

To assess the value of magnetic resonance imaging (MRI) in the investigation of patients with suspected but nonproven vertebral metastases 45 consecutive patients referred in a 6 month period with known primary malignancy and back pain in whom an isotope bone scan was reported as equivocal were studied. All patients had abnormal isotope uptake localized to the spine. Twelve patients were shown to have bony metastases on plain X-ray. In the remainder, where X-rays showed normal or benign appearance, MRI of the spine was offered. Twenty-four patients underwent MRI examination which showed vertebral metastases in 11 cases. Magnetic resonance imaging is shown to be a useful, noninvasive, complementary investigation for evaluation of patients known to have malignant disease and suspected of having vertebral metastases on bone scintigraphy.     

脊柱嗜酸性肉芽肿的螺旋CT表现

目的探讨脊柱嗜酸性肉芽肿的CT表现。方法搜集经病理组织学证实的脊柱嗜酸性肉芽肿患者15例,所有病例均行CT平扫及矢状位重建。结果 15例共累及23个椎体,单发10例,多发5例,其中颈椎6个,胸椎10个,腰椎7个。23个病灶均位于椎体,其中3个同时累及附件,2个累及椎弓根。23个病灶CT表现为椎体不同程度骨质破坏,其中19个椎体压缩变扁,13个病灶周围硬化,9个病灶于椎旁形成软组织肿块,1个椎间隙变窄。结论认识脊柱嗜酸性肉芽肿的CT表现,密切结合临床症状及实验室检查,有助于提高诊断的准确性。     

脊柱多发骨髓瘤与转移瘤的MRI鉴别诊断

目的 为了提高对脊柱多发骨髓瘤(multiple myeloma，MM)和转移瘤的影像诊断水平。方法 回顾性总结经骨髓涂片或局部病灶活检病理证实的脊柱多发骨髓瘤17例，脊柱转移瘤32例，分析二者的MRI特点，归纳其影像表现的差异。结果 脊柱多发骨髓瘤累及154个椎体，其中累及附件18个，占11．7％；椎体破坏变形8个，占5．2％；椎旁软组织多呈“围髓”生长。转移瘤累及椎体89个，多为跳跃状分布，累及附件45个，占50．6％；椎体破坏变形51个，占57．3％，椎旁软组织常以破坏区为中心生长。结论 MRI检查在鉴别脊柱多发骨髓瘤和转移瘤中可以提供可靠的信息。     

Imaging findings in patients with ventral dural defects and herniation of neural tissue

The aim of this paper is to describe clinical and imaging findings in three patients with ventral dural defects and herniation of the spinal cord or cauda equina. The literature is reviewed and the clinical, radiological and operative findings are compared. Three patients with ventral dural defects of different etiologies are presented. One patient gave a longstanding history of ankylosing spondylitis, the second patient presents 37 years after spinal trauma, and the third patient presents with spontaneous spinal cord herniation. All patients had typically slowly progressive neurological symptoms with multiple hospitalizations until diagnosis was made. Characteristic findings in postmyelographic CT included a ventral or ventrolateral displacement with deformation of the spinal cord or the cauda equina. Sagittal MRI showed this abrupt and localized anterior deviation of the spinal cord or the cauda equina to the posterior portions of a vertebral body with or without a bony vertebral defect optimally. Additionally, due to the ventral displacement of the spinal cord, the dorsal subarachnoid space was relatively enlarged without evidence of an arachnoid cyst, in all patients. Magnetic resonance imaging and postmyelographic CT can diagnose ventral dural defects with spinal cord herniation or nerve root entrapment. Dural defects must be considered in the presence of neurological symptoms in cases of longstanding ankylosing spondylitis, late sequelae of fractures of vertebral bodies, and without history of spinal trauma or surgery. Received 13 June 1996; Revision received 8 November 1996; Accepted 20 March 1997     

脊柱转移瘤在椎骨上的分布与血行播散模式(附68例分析)

目的：分析脊柱转移瘤的CT表现，探讨转移瘤在椎骨上的分布与血行播散模式的相关性。方法：68例经临床及组织学证实的脊柱转移瘤病人，每个椎骨在CT横断面上被分成18个部分，每个部分的病灶数被统计。结果：68例患者167个椎骨受累，共210个病灶，其中。196个定位于椎体，168个定位于椎体中后部，49个椎骨的椎弓根受到侵犯。结论：转移瘤在椎骨上的分布与血行播散模式相关(尤其是Batson静脉丛)，并且在鉴别诊断中也有意义。