脊柱原发性软骨肉瘤影像学表现及组织病理联系

目的分析脊柱原发性软骨肉瘤影像学表现,探讨其影像学特征及组织病理联系。资料与方法回顾性分析8例病理证实的脊柱原发性软骨肉瘤患者的临床表现、病理特征及影像学征象。结果 8例中普通型4例,间质型2例,透明细胞型和黏液型各1例;7例髓内型,1例皮质旁型。病灶均单发,累及胸椎3例(T4、T5和T11～12),骶椎3例(S1～3),腰椎和颈椎各1例。8例均表现为不同程度溶骨性骨质破坏和软组织肿块。7例病灶内见环状或弧线样软骨基质钙化。3例T2WI上见分叶状更高信号区(富水分区)病灶中,2例为传统型,且含MRI液-液平面,病理证实瘤灶内有动脉瘤样骨囊肿改变;另1例为透明细胞型,病理显示富含透明软骨成分;此两型共5例,其中4例MRI呈线样或分隔样强化。黏液型病灶MRI信号混杂,但较传统型和透明细胞型信号相对均匀;除钙化区域外,瘤体呈弥漫强化。2例间质型病灶均表现为明显软组织肿块,均匀或不均匀强化。结论脊柱原发性软骨肉瘤具有特征性影像表现,不同影像学表现可提示不同病理类型。熟悉脊柱原发性软骨肉瘤影像学特征及不同病理类型特征性表现有助于临床及影像诊断。

Imaging Manifestations of Primary Spinal Chondrosarcoma:a Comparative Analysis with Histopathology

Objective To delineate the imaging findings of primary vertebral spinal chondrosarcoma and to find the correlation with pathology.Materials and Methods Eight cases of primary vertebral spinal chondrosarcoma histopathologically confirmed were collected.The clinical,pathological and radiological chararacteristics were analyzed retrospectively.Results Lesions were located in thoracic vertebras in 3,sacrum in 3,lumbar in 1 and cervical vertebra in one.All the lesions showed osteolytic destruction combined with soft masses.Ring or arch like calcifications were showed in 7 lesions on conventional radiographs and CT images.Histopathological results included conventional type in 4,mesenchymal type in 2,clear cell and myxoid variants in one each.Three conventional and 1 clear cell type lesions showed lobulated or irregular masses with typical line or septa enhancement on MR images.Except one presented heterogeneous,three of them showed hyperintensity signal on T2 weighted images.Among them,2 were conventional type lesions combined with aneurismal bone cyst and 1 clear cell type lesion fulled of hyaline cartilage inside.The myxoid type lesion showed a heterogeneous MRI signal intensity.The mass was diffusely enhanced except the area of calcification.Obvious masses with heterogeneous MRI signal were found in 2 mesenchymal type lesions.Conclusion Primary spinal chondrosarcomas have certain specific imaging features that may correlate to the pathological subtypes.Recognizing the specific manifestations of each type is useful for the diagnosis of primary spinal chondrosarcoma.