脊椎转移瘤的MRI诊断

目的 探讨脊椎转移瘤的MRI表现及鉴别诊断价值。方法 回顾性阅读103例经临床或病理证实的脊椎转移瘤患者的MRI片,并分析和记录各种征象。结果 103例共累及338个脊椎,其中3个仅累及附件,82个仅累及椎体,253个椎体和附件同时受累。依据椎体形态和椎体病变特点将椎体受累的335个脊椎分为四型：I型97个,椎体内单发病灶;Ⅱ型102个,椎体内多发结节病灶,边界较清晰;Ⅲ型16个,全部椎体信号异常;I—Ⅲ型椎体均无压缩。Ⅳ型120个,全部或大部椎体信号异常伴压缩骨折,其中114个椎体上和(或)下缘凹陷,116个椎体后和(或)前缘隆突。累及附件的256个脊椎中,238个有单侧或双侧椎弓根及椎体相邻部分同时受累,235个病变椎弓根及附件其他部分外形增大。软组织肿块见于133个病变脊椎,矢状位像上均以病变脊椎为中心,其中130个上下范围小于或略超过病变椎体高度。结论 脊椎转移瘤易累及多脊椎,根据病灶分布、脊椎形态及软组织肿块特点,MRI可对多数患者进行诊断和鉴别诊断。

MRI diagnosis of vertebral metastasis

Objective To study MRI changes of vertebral metastasis and their value in differential diagnosis. Methods MR films of 103 patients with vertebral metastasis confirmed clinically or pathologically were reviewed with all features recorded and analyzed. Results 338 vertebrae were involved in 103 patients, including 82 in vertebral body only, 3 in appendix only and 253 in both. According to the shape of vertebral body and the characteristic abnomality, 335 vertebrae with body involved were divided into 4 types: Type I (97) with one single focus in the vertebra] body, type II (102) with multiple foci with clear margin in the vertebral body, type I (16) with abnormal signal in the whole vertebral body and type IV (120) with abnormal signal in the whole or most part of vertebral body complicated with compression fracture. Among all these lesions, 114 showed concave superior and/or inferior edges and 116 protruding posterior and/or anterior borders. In 256 vertebrae with abnormal appendix, 238 showed abnormal pedicle of vertebral arch involving neighbouring part of vertebral body and 235 showed enlarged pedicle and other parts of the appendix. Soft tissue mass was showed around 133 vertebrae, with the center at the involved vertebrae on sagittal image. 130 pieces of these masses extended cranio-caudally within or a little beyond the width of a vertebral body. Conclusion Vertebral metastasis is characterized by involving multiple vertebrae. Its diagnosis and differential diagnosis can be made definite in most patients according to the lesions distribution, change in vertebral shape and the characteristics of the soft tissue mass.