原发性椎管内肿瘤的低场MRI诊断与鉴别诊断

目的探讨椎管内原发肿瘤的定位、定性诊断,提高椎管内肿瘤的诊断和鉴别诊断水平。方法回顾性分析71例经手术病理证实的椎管内原发肿瘤的MRI表现,总结椎管内髓内、髓外硬膜下和硬膜外肿瘤的不同MRI特征。结果髓内肿瘤14例,其中室管膜瘤7例,星形细胞瘤5例,血管母细胞瘤2例;髓外硬膜下肿瘤46例,包括神经鞘瘤19例,神经纤维瘤14例,脊膜瘤8例,脂肪瘤3例,表皮样囊肿和畸胎瘤各1例;硬膜外肿瘤11例,其中神经鞘瘤4例,神经纤维瘤3例,血管瘤2例,血管肌肉脂肪瘤和淋巴瘤各1例。71例椎管内肿瘤中,定位准确70例,准确率98.5%;定性准确58例,准确率81.7%。结论 MRI对原发性椎管内肿瘤的诊断定位较容易,根据肿瘤的位置、形态及信号特征结合临床和增强扫描观察,绝大部分肿瘤可作出定性诊断,MRI对椎管内肿瘤的诊断具有重要价值,是目前诊断椎管内肿瘤的首选方法。

MRI diagnosis of primary intraspinal tumors

Objective To determine the MRI diagnostic value of intraspinal tumors. Methods MRI of 71 pathologically confirmed primary intraspinal tumors was analyzed retrospectively. MRI characteristics of intramedullary, intradural extramedullary and extradural tumors were evaluated. Results There were 14 intramedullary tumors （7 ependymomas, 5 astrocytomas, 2 hemangioblastomas）, 46 intradural extramedullary tumors （19 Schwannomas, 14 neurofibromas, 8 meningiomas, 3 lipomas, 1 epidermoid cyst, 1 teratoma）, 11 extradural tumors （4 schwannomas, 3 neurofibromas, 2 angiomas, 1 angiomyolipoma and 1 lymphoma）. Accuracy of tumor localization was 98.5% （70/71）. Based on the location, shape, signal characteristics and contrast enhancement pattern, accurate diagnosis was established in 58/71 （81.7%） tumors. Conclusion MRI is accurate in localizing and characterizing primary intraspinal tumors.