磁共振诊断脊椎骨母细胞瘤的临床应用价值

目的:探讨脊椎骨母细胞瘤的磁共振(MRI)表现、诊断价值及其临床特点。方法:8例脊椎骨母细胞瘤患者,术前均行MRI检查,主要症状为四肢不全性瘫痪及疼痛,治疗上行肿瘤切除或刮除治疗,椎体病变者行植骨及内固定术。结果:8例均经病理确诊为骨母细胞瘤,其中6例为良性,2例为侵袭性。肿瘤起源于脊椎椎体2例,起源于脊椎附件6例;发病部位颈椎2例,胸椎3例,腰椎3例。脊椎骨母细胞瘤MRI主要表现为椎体或附件溶骨性膨胀性骨质破坏,T1WI上为低或等信号,T2WI上可为低、等或高多种信号成分,肿瘤内钙化或骨化在T2WI上为低信号,T1WI上为等或低信号;周边硬化环在T1WI和T2WI上均为低信号;软组织肿块较明显,向椎管突出可压迫脊髓;增强扫描肿瘤中度到明显强化,囊变、硬化边缘不强化。侵袭性骨母细胞瘤边界不清,可侵犯周围组织。结论:脊椎骨母细胞瘤发病年龄较轻,发病部位以脊椎附件较多见。MRI多方位、多序列成像及增强扫描,能较好显示脊椎骨母细胞瘤的各种病理改变,对诊断、手术定位、分期尤其在显示脊髓继发改变有重要价值。

Spine osteoblastoma: the diagnositic role of MRI

Objective:To study the characterization of osteoblastoma on MRI and to discuss its diagnostic value to analyze its clinical feature.Methods:Eight patients all patients were examined with MR imaging before operation.Clinical symptoms of this disease were mainly limbs partial paralysis and pain.The methods of treatment were tumor resection or curettement,and vertebra tumor would plant bone and internal fixed.Results:All patients were determinately diagnosed as osteoblastoma by pathology.Of these patients,the tumor originated from spinal appendix in six patients,and from vertebra body in two patients.The tumor located the cervical vertebra in two patients,the thoracic vertebra and the lumbar vertebra in three patients respectively.Of these patients,benign osteoblastoma were in six patients and malignant were in two patients.On MRI,the tumor was an expanded and osteolytic lesion of vertebra body or appendix,osteoid production formation was low or equal signal intensity on T_1 images and low,medial or high signal intensity on T_2 images.MRI showed low signal intensity of the calcification or ossification in osteoblastoma on T_2-weighted imaging,and low or equal signal intensity on T_1-weighted images.The ossified ring of tumor was low signal intensity on both T_1-and T_2-weighted imaging.The adjacent soft tissue mass was showed on MRI and sticking out vertebral tube and compress the spinal cord.All patients given gadolinium showed enhancement within the osteoid production and the adjacent soft tissue mass,and no enhancement with ossification and calcification,cystoid and the ossified ring on MRI.The boundary of malignant osteoblastoma was obscure,and adjacent tissue could be invaded.Conclusion:The age of the spine osteoblastoma was younger and tumor mainly sited vertebra appendix.There was multi-orientation,multi-sequence imaging and the high resolution of soft tissue and Gd-DTPA enhanced MR imaging that could show all characteristic of osteoblastoma.It was very important to diagnosis,operative orientation and stage of osteoblastoma,especially for die lesion originated from spine.MRI was a preferred examination before operation.