单发脊髓血管母细胞瘤MRI表现及误诊分析  

MRI Findings and Misdiagnosis Analysis of Solitary Hemangioblastoma of the Spinal Cord

作　　者：李金禄 黄聪 赵梓霖 张恒胜 江桂华[3] LI Jin-lu;HUANG Cong;ZHAO Zi-lin;ZHANG Heng-sheng;JIANG Gui-hua(Department of Radiology,Longxi County Hospital of Traditional Chinese Medicine,Longxi,Gansu 748100,China;Department of Radiology,No.926 Hospital of PLA Joint Logistics Support Force,Kaiyuan,Yunnan 661699,China;Department of Radiology,the Second People's Hospital of Guangdong Province,Guangzhou 510000,China)

机构地区：[1]陇西县中医院放射科,甘肃陇西748100 [2]解放军联勤保障部队第926医院放射,云南开远661699 [3]广东省第二人民医院放射科,广州510000

出　　处：《临床误诊误治》2022年第9期22-25,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨单发脊髓血管母细胞瘤(HB)MRI表现,分析其误诊原因及防范措施。方法对2015年1月—2022年6月收治的经术后病理检查证实的单发脊髓HB 15例的临床资料进行回顾性分析。结果本组均表现为肢体麻木无力、疼痛、感觉减退,3例合并肌力减低及肌肉萎缩。15例均为单发髓内病灶,位于颈段9例,胸段5例,腰段1例。15例MRI主要表现为脊髓内椭圆形肿块,T1WI呈等或稍低信号,T2WI及STIR呈稍高信号,增强扫描病灶明显强化,强化程度类似血管。6例弥散加权成像呈等或稍低信号。14例伴发脊髓空洞,12例伴发脊髓肿胀,11例出现血管流空信号。本组11例术前误诊,误诊为星形细胞瘤7例,室管膜瘤2例,脊膜瘤和转移瘤各1例。误诊时间7~15 d。15例均行手术治疗,术后病理检查皆证实为脊髓HB,皆病情缓解后出院。12例随访3~19个月未见复发,3例失访。结论单发脊髓HB临床相对罕见,MRI表现多样,术前易误诊;提高对其临床及MRI表现认识,发散诊断思维,认真鉴别诊断,或可减少误诊误治。Objective To investigate the MRI findings of solitary hemangioblastoma(HB)of the spinal cord,and to analyze the causes of misdiagnosis and preventive meastures.Methods The clinical data of 15 patients with solitary HB of the spinal cord confirmed by postoperative pathology who were admitted from January 2015 to June 2022 were retrospectively analyzed.Results In this group,15 patients presented with limb numbness and weakness,pain,and hypoesthesia,and 3 patients had decreased muscle strength and muscle atrophy.All 15 cases had solitary intramedullary lesions,which were located in the cervical segment in 9 cases,the thoracic segment in 5 cases,and the lumbar segment in 1 case.The main MRI findings of 15 cases were oval masses in the spinal cord,with equal or slightly low signal intensity on T1WI,slightly high signal intensity on T2WI and STIR.The lesions were significantly enhanced on enhanced scan,and the degree of enhancement was similar to that of blood vessels.Diffusion weighted imaging showed equal or slightly low signal in 6 cases.There were 14 cases with syringomyelia,12 cases with spinal cord swelling,and 11 cases with vascular emptying signal.Of them,11 cases were misdiagnosed before operation,including 7 cases of astrocytoma,2 cases of ependymoma,1 case of meningioma and 1 case of metastatic tumor.The duration of misdiagnosis was 7-15 d.All 15 cases were treated surgically,and the pathological examination after operation confirmed that they had HB of the spinal cord.All were discharged after remission.Twelve cases were followed up for 3-19 months without recurrence,and 3 cases were lost to follow-up.Conclusion Solitary HB of the spinal cord is relatively rare in clinical settings with various MRI manifestations,which is,therefore,more likely to be misdiagnosed before operation.Improving the understanding of clinical and MRI manifestations,divergent diagnostic thinking and careful differential diagnosis may help reduce misdiagnosis and mistreatment.

关 键 词：血管母细胞瘤 脊髓 误诊 星形细胞瘤 室管膜瘤 磁共振成像 

分 类 号：R739.42[医药卫生—肿瘤]