脊柱腫瘤影像學(xué)診斷講座

1、胸段 T重建重建LC 臨床病理臨床病理 影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)Fig. A thickened trabeculae (corduroy sign) of a vertebral body hemangioma can be seen on this lateral view, which is coned down to the L2 vertebral bodyFig. B T1WI and Fig. C T2WI show the typical increased signal intensity of a vertebral bodyABC 臨床病理臨床病理影像表現(xiàn)影像表現(xiàn)

2、影像表現(xiàn)影像表現(xiàn)38, yr, M of CHereditary multiple exostosis with several spinal osteochondromasFigA: Lateral radiograph of the cervical spine shows a C-4 spinous process osteochondroma with pathognomonic marrow and cortical continuity solid arrow). Osteochondroma at C-1 is seen as an ossified region (open r

3、row)Axial FigB and sagittal FigC reconstructed CT scans reveal cortex and marrow of the osteochondroma (arrows), impingement on the spinal canal, extrinsic erosion of C-2 (arrowheads in b), and continuity with the C-1 spinous process (* in c). Sagittal T1-weighted FigDand T2* gradient-echo FigEMR im

4、ages reveal the signal intensity characteristic of yellow marrow within the osteochondroma and the impression of the tumor on the spinal canal (arrows), although the marrow and cortical continuity is not well seen. FigF: Photograph of the gross specimen shows the marrow and cortex of the osteochondr

5、oma and a small cartilage cap at its periphery (arrowheads).35yr，F(xiàn) Osteochondroma of sacrummalignant transformationFigAVague sclerosis (solid arrows) over the left sacrum and widening of the sacroiliac joint (open arrow).FigAFigCAxial CT scan shows the thick cartilage cap (arrows) and sacroiliac joi

6、nt invasion, which represents malignant transformation.FigB Coronal reconstructed CT scan shows the cortex and marrow canal of the osteochondroma (arrows) and continuity with the sacrum (arrowheads).Fig BFigCmultiple hereditary exostoses. Note that the large sacral lesion has normal cortex as well a

7、s marrow arising from the underlying bone. This appearance defines an exostosis. We look for a thick cartilage cap to suggest degeneration of an exostosis to a chondrosarcoma. In this case, there is no space for a thick cap because the edge of the exostosis extends to the subcutaneous tissue. If the

8、re is any question, MR imaging can demonstrate the cartilage thickness. In this case, we recognized multiple exostoses because of the presence of sessile lesions at the anterior superior iliac spines.10, yr, M Multiple hereditary exostoses臨床病理臨床病理影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)Fig A and Fig B a large expansile les

9、ion of the T-4 vertebral body (arrows), with extension into the posterior elements of T-3 and T-4 and the posterior soft tissues (arrowheads). The lesion enhances markedly with the contrast agent. FigC the lesion has only intermediate signal intensity, 28,yr,FGCT of T-3 and T-4Sag.T1WIAxi.T1WI +cSag

10、.T2WIIntraoperative photograph obtained after incision of the skin shows a bulging, solid paraspinal mass (*)FigDsacral GCT.A-PLateraLFig AFig bAxial CTSag.T2WI soft-tissue extension.Cor.T2WIFig CFig DFig EFig FGCT of S4-521 yr ,FA-PLateraLABFigC:CTshowing large mass of SFigD: demonstrating an inhom

11、ogeneous mass that contains several areas of low signal intensity (arrows; contrast this signal to the very high signal intensity FigE: revealing that the lesion is of low signal intensity; the large presacral mass displacing the rectum is confirmed. FigF:revealing only mild enhancement, again with

12、several areas of relatively low signal intensity. These low-signal regions represent a common feature in GCTsAxial CTSag. T1WIAxi. FSE T2WISag. FS T1WI +CUpper Left: Anteroposterior radiograph emonstrating the expanded lytic lesion ccupying the sacrum. Upper Right and Center Left: Axial CT scans obt

13、ained several months later, demonstrating the rather featureless lytic lesion occupying the entire sacrum, with attempted thin cortical rim unable to contain the expansive lesion. Center Right: Sagittal T1-weighted MR image (TR/TE 450/10 msec) demonstrating intensity presacral soft-tissue extensionL

14、ower Left and Right: Sagittal T2WI and axial FSE T2WI revealing the inhomogeneous mixed high and low signal intensity mass, typical of GCT.26, yr, F GCT of the sacrum.GCT of C-7 posterior elements16 y male 臨床病理臨床病理影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)FigA: Radiograph reveals a subtle lucent area (arrow) in a right artic

15、ular mass.FigB: CT scan 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 th

16、e radionuclide by the nidus (arrow) 17, yr, M Osteoid osteoma of lamina at T-11 FigE: Photograph of the gross specimen reveals the nidus (*)extending to the facet cartilage (arrows)Axial CT scan (left) revealing that a tumor arising from the left C-5 pedicle is compressing the left C-5 root.Bone sca

17、n (center) displays high uptake of contrast material. Axial CT scan (right) demonstrating that left hemilaminectomy was sufficient to remove the tumor.16, yr, M Osteoid osteoma of lamina at C-5 臨床病理臨床病理影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)Fig.Ashows a markedly expansile lesion involving the spinous process and laminae (

18、arrows), with vague sclerosis suggestive of mineralization. Fig.BCT scan reveals the marked expansion of the lesion, which has a defined sclerotic rim (arrows), and its encroachment on the spinal canal. Matrix mineralization (arrowheads), 16, yr, M. osteoblastoma of C-3 Fig.A L radiographFig.B CTAxi

19、. T1WI FigCand Sag. T2WI FigD show the mass (arrows) and its degree of encroachment on the spinal canal (arrowheads in c). Because of its extensive mineralization, the mass has relatively low signal intensity on the T2-weighted image. Axi. T1WISag. T2WIFigCFigD:FigEFigA: CT scan shows a destructive,

20、 expansile lesion of the left lateral side of C-1 (arrows) with small foci of mineralized matrix peripherally (arrowheads) and invasion of the surrounding soft tissues and foramen transversarium. FigB: Coronal T2-weighted MR image shows high signal intensity within the mass (arrows). FigC: Digital s

21、ubtraction angiogram reveals tumor stain (straight arrows) and obstruction of the left vertebral artery (curved arrow).9, yr, M. Aggressive osteoblastoma of C1Left: Anteroposterior radiograph revealing a subtly expanded lesion that is near the midline at S4-5 (arrows). Right: Axial CT scan demonstra

22、ting bone matrix within the lesion, not aggressive in appearance.16, yr, M osteoblastoma of S4-5 Left: bone scan revealing an eccentrically located area of increased uptake in the sacrum. Right: The CT scan demonstrates a minimally expanded lesion containing dense bone matrix in the right side of th

23、e lower sacrum. 16, yr, M. osteoblastoma of S4-5 Lateral x-ray films (a) showed a soft-tissue swelling in the retropharyngeal 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

24、peritumoral sclerotic rim on the right side of the C-2 body. Technetium bone scan (e) also displays pronounced uptake 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

25、 films obtained immediately after (h) and 2 years postsurgery (i) showing solid fusion.10, yr, M osteoblastoma of C2 臨床病理臨床病理影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)Fig.A and after Fig.B administration of gadopentetate dimeglumine reveal a markedly expansile lesion involving the laminae of T-3 (large arrowheads) and encroa

26、ching on the spinal canal (small arrowheads). Enhancement occurs largely in the periphery and septations of the lesion. Fig.C Sagittal T2-weighted MR image shows that the entire lesion contains fluid-fluid levels (arrows) resulting from hemorrhagic spaces and shows the extent of spinal canal narrowi

27、ng. 8yr, M ABC of T3ABC動脈瘤樣骨囊腫動脈瘤樣骨囊腫液-液平面(血竇)Photograph of the sagittally sectioned gross specimen demonstrates the multiple blood-filled spaces (arrows) in the lesion. Fig.D血竇血竇動脈瘤樣骨囊腫動脈瘤樣骨囊腫Fig.A The anteroposterior radiograph can be easily misread as normal because of the overlying bowel gas obs

28、curing the sacrumFig.B A lateral radiograph demonstrates only obscuration of the S-3 posterior elements (arrows)Fig.CThe lesion is more readily seen on the CT scan obtained with the patient in a prone position. This scan demonstrates a lytic lesion occupying the left S-3 ala, with a thin cortical ri

29、m surrounding the majority of the lesion. Note that the more lucent regions in the center of the lesion actually represent fluid levels. Fig.DFluid levels (short arrow) are more readily observed on a sagittal T1-weighted MR image; remember that the patient is supine in the imager and that the fluid

30、levels on the sagittal exam would then be expected to appear vertical, as in this case. The high signal intensity portion of the fluid is blood. Most, but not all, ABCs contain fluid levels. Conversely, most lesions with substantial fluid levels are ABCs, but such levels may occur in other lesions a

31、s well. Note also in this case that there is a substantial component of the lesion located anteriorly to the fluid levels that is solid (long arrows). 14, yr, M ABC of SADCB液-液平面(血竇)動脈瘤樣骨囊腫動脈瘤樣骨囊腫neurysmal Bone CystFig.A Computed tomographic scan showing alytic lesion in the posterior elements of th

32、e vertebrae at the T10-T12 level, with expansion to the vertebral body from the left. This process with a thin periosteal border enters the spinal canal, pressing the cord forward and to the rightFig.B Magnetic resonance imaging after injection with gadolinium shows a nonhomogeneous multilobular les

33、ion at T10-T12 level, extradurally pressing the spinal cord forward and to the right, destroying the pedicle and the lamina of the vertebra.Fig.AFig.B動脈瘤樣骨囊腫動脈瘤樣骨囊腫臨床病理臨床病理影像表現(xiàn)影像表現(xiàn) vertebra plana can be seen (arrow) in the thoracic spine, which is consistent with Langerhans cell histiocytosis.8, yr,

34、 M of T臨床病理臨床病理影像表現(xiàn)影像表現(xiàn)Fig.A Lateral radiograph shows a sclerotic focus in the anterior portion of L-3 (arrowhead). Fig.B CT scan reveals a densely sclerotic lesion with an irregular spiculated border just beneath the anterior cortex to the left of midline (arrowheads)66-yr-old M Enostosis of L-3Fig

35、.AFig.BFig.A Lateral radiograph reveals a sclerotic focus (large arrows) with areas of spiculated thornlike margins (small arrows). Fig.B Photomicrograph (original magnification, X150; hematoxylin-eosin stain) shows cortical bone (arrows) with irregular margins (arrowheads). 35-yr-old FGiant enostos

36、is of L-2Fig.BFig.B脊柱惡性腫瘤脊柱惡性腫瘤臨床病理臨床病理影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)Fig.ALateral radiograph shows destruction of the distal sacrum and coccyx with calcification (arrow). Fig.BCT scan also demonstrates the bone destruction and a soft-tissue mass (arrowheads) containing calcifications (arrow). . Chordoma o

37、f lower sacrum 48-year-old manFig.AFig.B脊索瘤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Fig.E As seen in this sagittal section of the gross specimen, the MR imaging appearance correlat

38、es with the expansile lesion (arrowheads) and calcification (arrow). The upper sacrum (*) is spared脊索瘤Fig.ALateral radiograph shows a dense vertebral body (arrows) at L-3. Fig.BSagittal reconstructed CT scan obtained after initial open biopsy reveals not only the L-3 sclerosis but also similar findi

39、ngs 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Sagittal T1WIFig.Cand T2WIFig.D MR images better delineate the marrow involvement at L-3 and L-4 with extension through the disk (arrows). The mass has marked high sig

40、nal intensity on d. Fig.CFig.DFig.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Upper Left and Right: Axial CT scans demonstrating a large soft-tissue mass extending anteriorly

41、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 perivesi

42、cal fat but not invading the bladder. 24-yr Mchordoma involving S3-5脊索瘤Fig.A and B: Preoperative axial CT scan and MR image revealing a sacral chordoma. Fig. C: Photograph of a hemisection of gross pathological specimen demonstrating complete en block resection of the sacrum. Fig. D and E: Postopera

43、tive anteroposterior and lateral radiographs.Fig.脊索瘤chordomaFig.AFig.B脊索瘤脊索瘤 臨床病理臨床病理影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)Magnetic resonance imaging study of the spine shows a destructive lesion in the second lumbar vertebra with extension into the spinal canal.Abdominal computed tomographic scan shows hepatic metastase

44、s and an irregular mass in the region of the pancreas.Fig.AFig.BFig.BFig.Asclerotic metastasesFigure. Sagittal T1-weighted MR image of the lumbosacral spine shows multiple hypointense foci within the sacrum and lumbar vertebrae. These lesions remained hypointense with all of the MR imaging sequences

45、 and did not exhibit enhancement. Plain radiography revealed sclerotic metastases.77-yr FMetastatic breast cancerExtensive osseous metastases from lung carcinoma. Anterior (left) and posterior (right) wholebodybone scintigrams show multiple, randomly distributed foci of abnormal radiotracer uptake.

46、The focivary in size and intensity.Fig.A : Sagittal T2-weighted 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.E : Bone sca

47、n demonstrating numerous additional sites of metastatic disease (ribs, skull, and scapula) in addition to L-3 (arrow). The patient underwent simple posterior decompression.54-yr Mmetastatic renal cell carcinomaABCSag.MRI of the lower T and upper T are (A)hypointense on T1WI and (B) hyperintense onT2

48、 WI). On DW EPI (C, b value of 440 sec/mm2; D, b value of 880 sec/mm2), the vertebral metastasis and vertebral compression fractures appear hyperintense.E, ADC map shows both vertebral metastasis and acute pathologic vertebral compression fractures with low ADCs, which indicate hindered diffusion of

49、 water protons and the pathologic nature of these findings. Note the hyperintense area located centrally in the fracture of L1, which possibly indicates unhindered diffusion in an area of debris.63-yr F with breast Ca.M at L1 (arrows)fractures at T11-12 (arrowheads)50-yr Fbreast carcinomamastectomy

50、5 yrs earlierLeft: Postoperative plain nteroposterior radiograph obtained after T-2 corpectomy and T1-3 stabilization performed via a median sternotomy approach (note the sternal wires (arrow) Right: Postoperative axial CT scan demonstrating good spinal decompression, structural iliac crest autograf

51、t strut, and an anterior plate. 62-yr Mlarge cell Caof the lung Neuroimages demonstrating reconstruction after C-4 corpectomy for a renal cell metastasis; stabilization was achieved using a titanium mesh interbody cage and chest tube construct filled with PMMA, supplemented by an anterior cervical p

52、late. Left: Preoperative T2-weighted magnetic resonance image, sagittal view, revealing VB collapse at C-4. Right: Postoperative cervical x-ray film, lateral view.Fig.A Preoperative plain x-ray film showing marked destruction of the C-3 VB and associated kyphotic eformity. Fig.B Postoperative x-ray

53、film showing placement of the TPS device into the C-3 corpectomy defect, restoring anterior column height. Fig.C Illustrations of the TPS device. The apparatus is expandable to fit the size of the corpectomy defect and can be filled with bone autograft if desired. Squamous cell carcinoma of the lung

54、 metastatic to C-3. ABC臨床病理臨床病理影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)Left: Anteroposterior radiograph revealing a highly destructive lytic lesion involving both the left iliac wing and left sacrum. Right: Axial CT scan confirming involvement of both of these bones, as well as a moderate-sized soft-tissue mass. Plasmacyto

55、mas may be very large and elicit no osseous reaction, as in this case. This case also demonstrates the propensity of aggressive lesions to cross the sacroiliac joint. 61-year-old man with multiple myeloma.Lytic expansile mass of C5. TransverseCT image at level of C5 shows expansilesoft-tissue mass a

56、long right side of C5 vertebral body, with associated bone destruction.Comparative images from sagittal reformatted CT data set (left) and sagittal STIR MRI(right) of thoracic spine show multiple compression fractures of thoracic vertebral bodies, with severethoracic kyphosis and marked osteolysis o

57、f the T1 vertebral body(arrow).Multiple compression fractureson CT and MRMRCT骨溶解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 tran

58、sverse and sagittal (a, left) MRI show cord compression by a focal expansile mass (arrow) at the T10 spinous process.abcThis lateral postoperative plain radiograph was obtained after vertebroplasty was performed to treat fractures of T-11, T-12, and L-1, which produced dramatic symptomatic relief (m

59、inimal cement leak into disc space at L-1, which was asymptomatic).59-yr Mmultiple myeloma臨床病理臨床病理影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)影像表現(xiàn)Fig.A Chest radiograph shows mild scoliosis and a paraspinal mass (arrow). Lateral radiograph (not shown) did not reveal prominent destruction.Fig.B CT scan reveals chondroid matrix mine

60、ralization in both the osseous lesion (arrowheads) and the associated anterior soft-tissue mass (arrows). 54-yr-old FChondrosarcoma of TFig.AFig.BFig.C and Fig.D T2* gradient-echo MR images reveal T-6 involvement with marrow replacement (small arrows) and a paravertebral mass (large arrows), which h