脊柱肿瘤和肿瘤样病变

1、会计学1脊柱肿瘤和肿瘤样病变脊柱肿瘤和肿瘤样病变第1页/共105页第2页/共105页第3页/共105页第4页/共105页第5页/共105页第6页/共105页第7页/共105页第8页/共105页第9页/共105页第10页/共105页第11页/共105页第12页/共105页第13页/共105页第14页/共105页第15页/共105页T12第16页/共105页第17页/共105页第18页/共105页第19页/共105页FigA: Radiograph reveals a subtle lucent area (arrow) in a right articular mass.FigB: CT sca

2、n shows the nidus (large arrowheads) with a small central area of calcification (small arrowhead) and minimal surrounding sclerosis. FigC: Radiograph of the resected specimen shows that the nidus was entirely removed (arrows).FigD: Posterior bone scan shows intense uptake of the radionuclide by the

3、nidus (arrow) 17, yr, M Osteoid osteoma of lamina at T-11 第20页/共105页第21页/共105页第22页/共105页第23页/共105页第24页/共105页第25页/共105页第26页/共105页第27页/共105页第28页/共105页Fig.A L radiographFig.B CT第29页/共105页Fig.D Sag. T2WIFig.C Axi. T1WI第30页/共105页第31页/共105页Lateral x-ray films (a) showed a soft-tissue swelling in the retro

4、pharyngeal space. Lateral (b) and coronal (c) MR images demonstrating tumor in the C-2 body and a soft-tissue mass from C16.Axial CT scan (d) demonstrating a typical osteoid nidus with peritumoral sclerotic rim on the right side of the C-2 body. Technetium bone scan (e) also displays pronounced upta

5、ke in this region. We performed tumor excision via an anterolateral retropharyngeal approach (f) occipitocervical fixation by using two axis plates and titanium wires (g). Lateral x-ray films obtained immediately after (h) and 2 years postsurgery (i) showing solid fusion.10, yr, M osteoblastoma of C

6、2 第32页/共105页第33页/共105页第34页/共105页第35页/共105页第36页/共105页第37页/共105页第38页/共105页第39页/共105页第40页/共105页第41页/共105页第42页/共105页第43页/共105页第44页/共105页第45页/共105页Fig.ALateral radiograph shows destruction of the distal sacrum and coccyx with calcification (arrow). Fig.BCT scan also demonstrates the bone destruction and

7、a soft-tissue mass (arrowheads) containing calcifications (arrow). . Chordoma of lower sacrum 48-year-old manFig.AFig.B脊索瘤第46页/共105页Fig.C T1WI Sagittal and axial T2WI Fig.DMR images reveal the expansile sacrococcygeal lesion (arrowheads), which has high signal intensity on D. Fig.CFig.D脊索瘤脊索瘤第47页/共1

8、05页Fig.E As seen in this sagittal section of the gross specimen, the MR imaging appearance correlates with the expansile lesion (arrowheads) and calcification (arrow). The upper sacrum (*) is spared脊索瘤第48页/共105页Upper Left and Right: Axial CT scans demonstrating a large soft-tissue mass extending ant

9、eriorly to involve the rectum and posteriorly to invade the buttocks; calcification is seen within the mass. Lower Left and Right: Sagittal fast spin echo T2-weighted and axial T2-weighted MR images demonstrating the lesion infiltrating the presacral region, extending to surround the rectum and the

10、perivesical fat but not invading the bladder. 24-yr Mchordoma involving S3-5脊索瘤第49页/共105页chordomaFig.AFig.B脊索瘤脊索瘤第50页/共105页残存椎间盘形成的“分节”现象第51页/共105页Fig.ALateral radiograph shows a dense vertebral body (arrows) at L-3. Fig.BSagittal reconstructed CT scan obtained after initial open biopsy reveals not

11、only the L-3 sclerosis but also similar findings in the superior aspect of L-4 (arrowheads). Chordoma of L 13-year-old man1-yr history of intermittent low back pain.Fig.AFig.B脊索瘤第52页/共105页Sagittal T1WIFig.Cand T2WIFig.D MR images better delineate the marrow involvement at L-3 and L-4 with extension

12、through the disk (arrows). The mass has marked high signal intensity on d. Fig.CFig.D第53页/共105页Fig.Egross specimen depicts the extent of the neoplasm, with diffuse involvement of L-3 (arrowheads), the adjacent disk (*), and the superior aspect of L-4 (arrows).Fig.E脊索瘤第54页/共105页第55页/共105页第56页/共105页第5

13、7页/共105页第58页/共105页第59页/共105页第60页/共105页第61页/共105页第62页/共105页Fig. Multiple plasmacytomas with cord compression.a Sagittal T1WI (left) andbSTIR (right) MRI of thoracic spine show scattered focal lesions involving vertebral bodies and posterior elements of thoracic spine. Bothc transverse and sagittal (a

14、, left) MRI show cord compression by a focal expansile mass (arrow) at the T10 spinous process.abc第63页/共105页Myeloma of T5-T7第64页/共105页 T1WI STIR T2WI STIR第65页/共105页第66页/共105页第67页/共105页第68页/共105页sclerotic metastases第69页/共105页第70页/共105页第71页/共105页Figure. Sagittal T1-weighted MR image of the lumbosacral

15、 spine shows multiple hypointense foci within the sacrum and lumbar vertebrae. These lesions remained hypointense with all of the MR imaging sequences and did not exhibit enhancement. Plain radiography revealed sclerotic metastases.77-yr FMetastatic breast cancer第72页/共105页Fig.A : Sagittal T2-weighte

16、d MR image demonstrating involvement of the posterior elements of L-3 (arrow). Fig.B : Axial T1-weighted MR image revealing the L-3 spinous process and lamina infiltrated by tumor, with anterior structures intact (arrow). Fig.c: Bone scan demonstrating numerous additional sites of metastatic disease

17、 (ribs, skull, and scapula) in addition to L-3 (arrow). The patient underwent simple posterior decompression.54-yr Mmetastatic renal cell carcinomaABC第73页/共105页第74页/共105页第75页/共105页第76页/共105页第77页/共105页第78页/共105页第79页/共105页第80页/共105页第81页/共105页第82页/共105页第83页/共105页第84页/共105页第85页/共105页第86页/共105页第87页/共105页第88页/共105页第89页/共105页vertebra plana can be seen (arrow) in the thoracic spine