脊柱单椎体病变158例影像学分析  

The imaging analysis of solitary lesions in spine

作　　者：王筱璇 马晓文[1] 张玉婷[2] 贺雁 李海燕[1] WANG Xiaoxuan;MA Xiaowen;ZHANG Yuting;HE Yan;LI Haiyan(Department of MR,Red Cross Hospital,Xi′an Jiaotong University,Xi′an 710054,China)

机构地区：[1]西安交通大学附属红会医院磁共振室,西安710054 [2]西安交通大学附属红会医院CT室,西安710054

出　　处：《实用医学杂志》2019年第3期483-488,共6页The Journal of Practical Medicine

摘　　要：目的分析脊柱单椎体病变的影像学表现,以提高此类疾病的认知及疾病诊断水平。方法回顾2011年1月至2018年1月经手术病理证实的158例脊柱单椎体病变患者的影像学资料,分析病灶骨质破坏形式、内部密度及信号特点、边缘有无硬化、边界是否清楚、有无软组织肿块及骨膜反应、椎间盘有无受累等。结果原发骨肿瘤及肿瘤样病变100例,转移瘤25例,感染性病变33例。男87例,女71例,发病年龄5～76岁,平均(46.3±7.2)岁。良性骨肿瘤13例,占8.23%,良性肿瘤样病变11例,占6.96%;中间型骨肿瘤21例,占13.29%,中间型肿瘤样病变4例,占2.53%;恶性骨肿瘤76例,占48.10%;感染性病变33例,占20.89%。良性骨肿瘤和肿瘤样病变分别以骨软骨瘤和纤维结构不良最常见,中间型骨肿瘤和肿瘤样病变分别以骨巨细胞瘤和朗格汉斯细胞组织细胞增多症最常见,恶性骨肿瘤以转移瘤、孤立性浆细胞瘤最常见,感染性病变以结核最常见。良性病变通常没有或仅有轻度骨质破坏,边界清楚,常伴硬化边,无骨膜反应及软组织肿块;中间型及恶性病变通常表现为骨质破坏伴软组织肿块、骨膜反应,此外,恶性病变往往边界不清。感染性病变区别于肿瘤及肿瘤样病变最显著的特点是累及邻近椎间盘。结论脊柱单椎体病变具有一定规律,掌握其特点有助于良恶性骨肿瘤及肿瘤样病变与感染性病变的诊断和鉴别诊断。Objective Exploring the imaging findings of solitary lesions in spine to improve the diagnosis level of these diseases. Methods 158 cases of solitary lesions in spine confirmed by pathology from Jan 2011 to Jan 2018 were retrospectively analyzed on bone destruction,intralesional density,signal features,marginal sclerosis,boundary,soft tissue mass,periosteum reaction and involvement of intervertebral disc. Results There were 100 cases of primary bone tumors and tumor-like lesions,25 cases of metastatic tumors and 33 cases of infectious diseases. 87 male and 71 female were included,with a mean age of(46.3 ± 7.2)years(range:5 ~ 76). There were 13 cases(8.23%)of benign bone tumors and 11 cases(6.96%)of benign tumor-like lesions,21 cases (13.29%) of intermediate bone tumors and 4 cases(2.53%) of intermediate tumor - like lesions,76 cases (48.10%) of malignant tumors and 33 cases (20.89%) of infectious diseases. Osteochondroma and fibrous dysplasia were the most common type of benign bone tumors and tumor-like lesions,respectively. Giant cell tumor and langerhans cell histiocytosis were the most common type of intermediate bone tumors and tumor-like lesions, respectively. Metastases and solitary plasmacytoma were the most common types of malignant tumors. Tuberculosis was the most common type of infectious diseases. Benign lesions usually have no or mild bone destruction. Clear boundary and marginal sclerosis were common,while periosteum reaction and soft tissue mass were rarely seen in benign lesions. Bone destruction with soft tissue mass and periosteum reaction were common in intermediate and malignant lesions. Moreover,malignant tumors usually had obscure boundary. Involvement of adjacent intervertebral disc was the most significant difference between infectious diseases and tumors and tumor-like lesions. Conclusions Solitary lesions in spine have certain regularity,which is helpful for the diagnosis and differential diagnosis of benign,malignant tumors and tumor-like lesions and infectious diseases.

关 键 词：脊柱 肿瘤 感染 影像学 

分 类 号：R738[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R730.44