脊柱骨巨细胞瘤影像学分析及鉴别诊断  

Imaging analysis and differential diagnosis of giant cell tumor of spine

作　　者：牛富业 徐才国 尹雪军 何东雷 刘林 Niu Fuye;Xu Caiguo;Yin Xuejun;He Donglei;Liu lin(Department of Radiology,Eastern Theater Naval Hospital of the PLA,Zhoushan 316000,China)

机构地区：[1]解放军东部战区海军医院放射科

出　　处：《中华消化病与影像杂志（电子版）》2019年第2期68-71,共4页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

摘　　要：目的,分析脊柱骨巨细胞瘤的影像学表现,提高术前诊断水平。方法,对36例经手术病理证实的脊柱骨巨细胞瘤的X线、CT和MRI资料进行回顾性分析。结果,发生于颈椎7例,胸椎16例,腰椎6例,骶椎7例。合并动脉瘤样骨囊肿9例。影像学表现为偏心性、膨胀性骨质破坏25例,27例首次手术患者伴发病理性骨折12例,椎管狭窄21例,周围软组织肿块形成20例,囊变17例。9例复发者均合并软组织肿块及椎管狭窄,病灶边界不清,囊变、出血7例。MRI多表现为T1WI呈等、低信号,T2WI呈等、低或混杂高信号。合并动脉瘤样骨囊肿者表现为多囊状高信号,内可见液-液平面。结论,脊柱骨巨细胞瘤影像学表现具有一定的特征性,CT和MRI结合分析,可以提高术前诊断率,对临床分期、手术方案制定及术后评估具有重要价值。Objective To analyze the imaging features of giant cell tumor(GCT)in the spine,and to improve the diagnosis. Methods The plain radiography,CT and MRI data of 36 patients with GCT in the spine confirmed by postoperative pathology were retrospectively analyzed. Results Of the 36 cases,7 were found in the cervical spine,16 in the thoracic spine,6 in the lumbar spine,and 7 in the sacral spine.Aneurysmal bone cyst(ABC)was simultaneously detected in 9 of 36 cases.Typical features of the radiology show eccentric and distensible bone destruction of the involved vertebra in 25 cases.Twelve of the 27 cases without prior operation were detected pathologic fracture on imaging,spinal canal stenosis in 21,paraspinal soft tissue mass in 20 and cystic change in 17.Nine recurrent patients showed soft tissue mass without clear boundary and spinal canal stenosis.Seven of them showed cystic change and hemorrhage.Most lesions showed hypointense or isointense on T1-weighted imaging(T1WI)and hypointense,isointerse or heterogeneous high signal on T2-weighted imaging(T2WI).When ABC was detected,MRI revealed a mass with a fluid-fluid interface with polycystic hyperintense signal. Conclusion Radiographic features of the GCT in the spine are specific for diagnosis to some extent.Multiple imaging methods may contribute to the accuracy of preoperative diagnosis.CT combined with MRI has important value in GCT preoperative diagnosis,clinical staging,surgical strategies and postoperative evaluation.

关 键 词：脊柱 骨巨细胞瘤 计算机体层摄影术 磁共振成像 

分 类 号：R738[医药卫生—肿瘤]