MRI误诊的椎体海绵状血管瘤18F-FDG PET/CT显像一例

笔者报道了一例双下肢乏力4月余,加重伴疼痛、活动受限一周的病例。MRI显示病灶累及胸3椎体、椎体附件和周围组织,并延伸到椎管内硬脊膜,增强后病变明显强化,MRI因病变范围广且增强后明显强化,考虑为恶性肿瘤。而18F-FDG PET低代谢结合CT点状、栅栏状钙化灶和椎体骨质无破坏,考虑为海绵状血管瘤;且术后病理因病灶内见异常血管聚集成丛状,血管腔内有大量红细胞,诊断为海绵状血管瘤。文献复习加深了对椎体海绵状血管瘤的认识,其可累及椎体、椎体附件,甚至延伸到椎管内和（或）周围组织。海绵状血管瘤是一种血管畸形,MRI增强后呈明显强化,但是PET显像则呈低代谢。当MRI显示病变范围广伴明显强化,而椎体无骨质破坏,怀疑恶性肿瘤时,应结合PET/CT对诸如海绵状血管瘤等良性病变进行鉴别诊断。

18F-FDG PET/CT findings of a thoracic vertebral cavernous hemangioma: a case of MRI misdiagnosis

We report a 69-year-old female with nearly 4 months of bilateral lower limb weakness and about 1 week of limited activity and pain. MRI of the thoracolumbar spine revealed that the lesion was mainly on the vertebral body and the corresponding intraspinal, epidural, and paravertebral soft tissues. In the Gd-enhanced images, the lesion was highly apparent and was diagnosed as a malignant tumor. However, the punctate bone density was increased upon PET/CT and 18F-FDG uptake was low. Furthermore, PET/CT imaging showed a cavernous hemangioma, and this was confirmed by histological examination of the tumor. The understanding of the cavernous hemangioma was deepened by literature review. A cavernous hemangioma can involve the vertebral body and vertebral appendages, and can even extend into the spinal canal and surrounding tissues. Cavernous hemangioma is a benign vascular malformation. The Gd-enhanced imaging is a valuable enhancement tool. Moreover, PET showed low 18F-FDG uptake. When the MRI lesions are widespread and obvious, malignancy should not be ruled out. Furthermore, PET/CT should be used for the differential diagnosis of benign lesions, such as cavernous hemangioma.