脊柱肿瘤ppt课件

1、脊柱病变的影像学诊断脊柱病变的影像学诊断 ct脊柱检查脊柱检查ct脊柱检查脊柱检查mri检查脊柱的优势n总体优势：n 多参数成像n 多方位成像，尤其矢状断层n独特优势：n 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degeneration椎间盘变性：set2 gre t2* t1wi椎体终板信号改变：degenerationnormalpost-radiotherapydisc-herniationdisc-herniationdisc-herniationdisc-herniationdisc-herniationdisc-herniation椎管狭窄椎管狭窄分型：中心型外围型先天型

2、后天型颈颈椎椎病病disc-herniationbasal depressionspinal canal stenosis opll 脊柱创伤n观察脊髓的受伤程度： 水肿、肿胀、出血、断裂、软化n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n观察椎管的其他改变： 增生、狭窄脱位:位置错位置错位位 3.5cm成角成角 11度traumatrauma脊髓震荡脊髓震荡脊髓受压脊髓受压脊髓挫伤脊髓挫伤脊髓损伤脊髓损伤三型三型:1 挫伤挫伤伴出血伴出血2 水肿水肿3 混合混合traumatraumatrauma椎管肿瘤n髓内肿瘤n髓外硬膜下肿瘤n硬膜外肿瘤ependymoma(室管膜瘤室

3、管膜瘤) )nthe most common intramedullary spinal neoplasm in adults, 60% , 38.8 , male ncervical cord alone the upper thoracic region. nmyxopapillary ependymomanduration of symptoms was 36.5 months nback or neck pain (67%), sensory deficits (52%), motor weakness (46%), imaging characteristicsnct x-ray:

4、scoliosis or canal widening with associated vertebral body scalloping, pedicle erosion, or laminar thinning nmri: t1wi iso- or hypointense; t2wi hyperintense the cap sign, a rim of extreme hypointensity (seen at the poles of the tumor on t2wi. cord edema. 3.6 vertebral segments; cysts are a common ,

5、 syringohydromyelia well contrast-enhanced室管膜瘤室管膜瘤髓内肿瘤髓内肿瘤室管膜瘤室管膜瘤室管膜瘤室管膜瘤astrocytoma (星形细胞瘤星形细胞瘤) )none-third of all spinal cord gliomas； male； 29 years；thoracic cord (67% ), cervical cord (49%) ；involvement of the entire spinal cord；rare filum terminale ；rarely exophytic.npain and sensory deficits

6、 ；motor dysfunction.nyoung children, with a median duration of 5 months.pathologic characteristics nill-defined diffuse fusiform enlargement. ntumor cysts (eccentric, smaller, and irregular) and syrinxes are common nhypercellularity and the absence of a surrounding capsule nenlarged, irregularly sha

7、ped, hyperchromatic nuclei who classification n grade i： pilocytic astrocytomas 75% n grade ii ：fibrillary type n grade iii ：anaplastic astrocytomas 25% n grade iv ：glioblastoma multiforme distinctly uncommon imaging characteristics nct 、x-ray：mild scoliosis, widened interpedicular distance, and bon

8、e erosionnmri：poorly defined margins ；t1wi iso- to hypointense ； t2wi hyperintense；seven vertebral segments； cysts；eccentric； some enhancement 星形细胞瘤星形细胞瘤髓内肿瘤髓内肿瘤星形细胞瘤星形细胞瘤星形细胞瘤星形细胞瘤星形细胞瘤星形细胞瘤 characteristiccharacteristicependymomaastrocytoma population in which lesions population in which lesions mo

9、st commonly occur most commonly occuradultpediatric location in the spinal canal location in the spinal canalcentraleccentric morphologic appearance morphologic appearancewell circumscribedill defined hemorrhage hemorrhagecommonuncommon enhancement with contrast material enhancement with contrast ma

10、terialf o c a l , i n t e n s e homogeneousp a t c h y , irregular predilection for involvement predilection for involvement of the conus medullaris or filum terminale of the conus medullaris or filum terminaleyesnohemangioblastoma 血管母细胞瘤血管母细胞瘤nthoracic cord (50%), solitary ,younger than 40 ys .nhig

11、hly vascular, discrete, nodular, red-to-orange masses abutting the leptomeninges with prominent dilated and tortuous vessels on the posterior cord surface . syrinx is common imaging characteristics nct : hypoattenuated cystlike massnmri: diffuse cord expansion and variable signal intensity on t1wi,

12、isointense (50% o) or hyperintense (25%); t2wi high signal intensity with intermixed focal flow voids, cyst formation or syringohydromyelia ncystic mass with an enhancing mural nodule 血管母细胞瘤血管母细胞瘤血管母细胞瘤血管母细胞瘤metastasis (转移瘤）转移瘤）nsolitary, two to three vertebral segments, cervical cord nmild cord exp

13、ansion over several segments. t1wi central area of low signal intensity (mimicking a syrinx); t2wi high signal intensity ; ncysts are rare . enhance intensely and homogeneously 转移瘤转移瘤转移瘤转移瘤髓外硬膜下肿瘤脊膜瘤n增强扫描十分重要n可明确肿瘤位于硬膜内n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n沿神经鞘同时存在于椎管内外nt2w

14、i高信号n明显增强n内部多有坏死n多发神经纤维瘤神经纤维瘤神经纤维瘤神经纤维瘤神经鞘瘤神经鞘瘤teratoma其他肿瘤其他肿瘤teratomametastasissubdural cystsacrum canal cyst硬膜外肿瘤n单纯硬膜外软组织肿瘤n椎体肿瘤n椎体并软组织肿瘤metastasismetastasis-1metastasis-2脊索瘤脊索瘤metastasismetastasismetastasisacidophil granulomamultiple myeloma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 脊柱裂脊柱裂 脊髓栓系脊髓栓系脊脊膜膜膨膨出出脊髓纵裂脊髓纵裂tethered cordtethered cord脊髓空洞症n鉴别空洞的类型:先天性和继发