《脊柱肿瘤》ppt课件

脊柱病变的影像学诊断山东省医学影像学研究所李传亭CT脊柱检查CT脊柱检查MRI检查脊柱的优势总体优势：多参数成像多方位成像，尤其矢状断层独特优势：目前唯一能直接显示脊髓内部的影像检查方法椎间盘病变椎间盘及椎体的退变椎间盘膨出和脱出从脊柱长轴全面观察以免漏掉其他病变观察突出椎间盘对脊髓或神经根的压迫程度DEGENERATION椎间盘变性：SET2GRET2*T1WI椎体终板信号改变：DEGENERATIONNormalPost-radiotherapyDISC-HERNIATIONDISC-HERNIATIONDISC-HERNIATIONDISC-HERNIATIONDISC-HERNIATIONDISC-HERNIATION椎管狭窄分型：中心型外围型先天型后天型颈椎病DISC-HERNIATIONBASALDEPRESSIONSPINALCANALSTENOSISOPLL脊柱创伤观察脊髓的受伤程度：水肿、肿胀、出血、断裂、软化观察椎体的状况：有形态改变的骨折无明显形态改变的小梁骨折观察椎管的其他改变：增生、狭窄脱位:位置错位3.5cm成角11度TRAUMATRAUMA脊髓震荡脊髓受压脊髓挫伤脊髓损伤三型:1挫伤伴出血2水肿3混合TRAUMATRAUMATRAUMA椎管肿瘤髓内肿瘤髓外硬膜下肿瘤硬膜外肿瘤髓内肿瘤IntramedullarySpinalNeoplasmsEpendymoma(室管膜瘤)Themostcommonintramedullaryspinalneoplasminadults,60%,38.8,maleCervicalcordalonetheupperthoracicregion.MyxopapillaryependymomaDurationofsymptomswas36.5monthsBackorneckpain(67%),sensorydeficits(52%),motorweakness(46%),ImagingCharacteristicsCTX-ray:scoliosisorcanalwideningwithassociatedvertebralbodyscalloping,pedicleerosion,orlaminarthinningMRI:T1WIiso-orhypointense;T2WIhyperintensethecapsign,arimofextremehypointensity(seenatthepolesofthetumoronT2WI.cordedema.3.6vertebralsegments;Cystsareacommon,SyringohydromyeliaWellcontrast-enhanced室管膜瘤髓内肿瘤室管膜瘤室管膜瘤Astrocytoma(星形细胞瘤)One-thirdofallspinalcordgliomas；Male；29years；thoraciccord(67%),cervicalcord(49%)；Involvementoftheentirespinalcord；rarefilumterminale；rarelyexophytic.Painandsensorydeficits；Motordysfunction.Youngchildren,withamediandurationof5months.PathologicCharacteristicsIll-defineddiffusefusiformenlargement.Tumorcysts(eccentric,smaller,andirregular)andsyrinxesarecommonHypercellularityandtheabsenceofasurroundingcapsuleEnlarged,irregularlyshaped,hyperchromaticnucleiWHOclassificationGradeI：pilocyticastrocytomas75%GradeII：fibrillarytypeGradeIII：anaplasticastrocytomas25%GradeIV：glioblastomamultiformedistinctlyuncommonGradeIIGradeIVImagingCharacteristicsCT、X-ray：mildscoliosis,widenedinterpediculardistance,andboneerosionMRI：poorlydefinedmargins；T1WIiso-tohypointense；T2WIhyperintense；sevenvertebralsegments；Cysts；eccentric；someenhancement星形细胞瘤髓内肿瘤星形细胞瘤星形细胞瘤星形细胞瘤CharacteristicEpendymomaAstrocytomaPopulationinwhichlesionsmostcommonlyoccurAdultPediatricLocationinthespinalcanalCentralEccentricMorphologicappearanceWellcircumscribedIlldefinedHemorrhageCommonUncommonEnhancementwithcontrastmaterialFocal,intensehomogeneousPatchy,irregularPredilectionforinvolvementoftheconusmedullarisorfilumterminaleYesNoHemangioblastoma血管母细胞瘤Thoraciccord(50%),solitary,youngerthan40ys.Highlyvascular,discrete,nodular,red-to-orangemassesabuttingtheleptomeningeswithprominentdilatedandtortuousvesselsontheposteriorcordsurface.SyrinxiscommonImagingCharacteristicsCT:hypoattenuatedcystlikemassMRI:diffusecordexpansionandvariablesignalintensityonT1WI,isointense(50%o)orhyperintense(25%);T2WIhighsignalintensitywithintermixedfocalflowvoids,cystformationorsyringohydromyeliacysticmasswithanenhancingmuralnodule血管母细胞瘤血管母细胞瘤Metastasis(转移瘤）Solitary,twotothreevertebralsegments,cervicalcordmildcordexpansionoverseveralsegments.T1WIcentralareaoflowsignalintensity(mimickingasyrinx);T2WIhighsignalintensity;Cystsarerare.Enhanceintenselyandhomogeneously转移瘤转移瘤髓外硬膜下肿瘤脊膜瘤增强扫描十分重要可明确肿瘤位于硬膜内可显示脊膜瘤的特征：宽基底附着于硬脊膜MENINGIOMAMENINGIOMA-1MENINGIOMA-2神经纤维（鞘）瘤沿神经鞘同时存在于椎管内外T2WI高信号明显增强内部多有坏死多发神经纤维瘤神经纤维瘤神经鞘瘤TERATOMA其他肿瘤TERATOMAMETASTASISSUBDURALCYSTSACRUMCANALCYST硬膜外肿瘤单纯硬膜外软组织肿瘤椎体肿瘤椎体并软组织肿瘤METASTASISMETASTASIS-1METASTASIS-2脊索瘤脊索瘤METASTASISMETASTASISMETASTASISACIDOPHILGRANULOMAMULTIPLEMYELOMA脊柱先天畸形脊髓脊椎的发育和解剖神经管闭合不全脊柱裂:隐性;伴脊膜膨出;伴脊髓脊膜膨出脊柱裂脊髓栓系脊膜膨出脊髓纵裂TETHEREDCORDTETHEREDCORD脊髓空洞症鉴别空洞的类型:先天性和继发性空洞和积水确认累及范围SYRINGOMYELIASYRINGOMYELIASYRINGOMYELIASYRINGOMYELIA(DIFFERENTTYPE)复习题1、急、慢性化脓性骨髓炎的发病过程和影像学表现。2、脊柱结核的影像学表现。3、化脓性关节炎与滑膜型关节结核的鉴别诊断。4、类风湿性关节炎的影像学表现。5、强直性脊柱炎的影像学表现6、退行性骨关节病的影像学表现特点。7、脊髓内星形细胞瘤与室管膜瘤的鉴别诊断谢谢