脊柱腫瘤ppt課件

1、脊柱病變的影像學(xué)診斷脊柱病變的影像學(xué)診斷 ct脊柱檢查脊柱檢查ct脊柱檢查脊柱檢查mri檢查脊柱的優(yōu)勢n總體優(yōu)勢：n 多參數(shù)成像n 多方位成像，尤其矢狀斷層n獨特優(yōu)勢：n 目前唯一能直接顯示脊髓內(nèi)部的影像檢查方法椎間盤病變degeneration椎間盤變性：set2 gre t2* t1wi椎體終板信號改變：degenerationnormalpost-radiotherapydisc-herniationdisc-herniationdisc-herniationdisc-herniationdisc-herniationdisc-herniation椎管狹窄椎管狹窄分型：中心型外圍型先天型

2、后天型頸頸椎椎病病disc-herniationbasal depressionspinal canal stenosis opll 脊柱創(chuàng)傷n觀察脊髓的受傷程度： 水腫、腫脹、出血、斷裂、軟化n觀察椎體的狀況： 有形態(tài)改變的骨折 無明顯形態(tài)改變的小梁骨折n觀察椎管的其他改變： 增生、狹窄脫位:位置錯位置錯位位 3.5cm成角成角 11度traumatrauma脊髓震蕩脊髓震蕩脊髓受壓脊髓受壓脊髓挫傷脊髓挫傷脊髓損傷脊髓損傷三型三型:1 挫傷挫傷伴出血伴出血2 水腫水腫3 混合混合traumatraumatrauma椎管腫瘤n髓內(nèi)腫瘤n髓外硬膜下腫瘤n硬膜外腫瘤ependymoma(室管膜瘤室

3、管膜瘤) )nthe most common intramedullary spinal neoplasm in adults, 60% , 38.8 , male ncervical cord alone the upper thoracic region. nmyxopapillary ependymomanduration of symptoms was 36.5 months nback or neck pain (67%), sensory deficits (52%), motor weakness (46%), imaging characteristicsnct x-ray:

4、scoliosis or canal widening with associated vertebral body scalloping, pedicle erosion, or laminar thinning nmri: t1wi iso- or hypointense; t2wi hyperintense the cap sign, a rim of extreme hypointensity (seen at the poles of the tumor on t2wi. cord edema. 3.6 vertebral segments; cysts are a common ,

5、 syringohydromyelia well contrast-enhanced室管膜瘤室管膜瘤髓內(nèi)腫瘤髓內(nèi)腫瘤室管膜瘤室管膜瘤室管膜瘤室管膜瘤astrocytoma (星形細胞瘤星形細胞瘤) )none-third of all spinal cord gliomas； male； 29 years；thoracic cord (67% ), cervical cord (49%) ；involvement of the entire spinal cord；rare filum terminale ；rarely exophytic.npain and sensory deficits

6、 ；motor dysfunction.nyoung children, with a median duration of 5 months.pathologic characteristics nill-defined diffuse fusiform enlargement. ntumor cysts (eccentric, smaller, and irregular) and syrinxes are common nhypercellularity and the absence of a surrounding capsule nenlarged, irregularly sha

7、ped, hyperchromatic nuclei who classification n grade i： pilocytic astrocytomas 75% n grade ii ：fibrillary type n grade iii ：anaplastic astrocytomas 25% n grade iv ：glioblastoma multiforme distinctly uncommon imaging characteristics nct 、x-ray：mild scoliosis, widened interpedicular distance, and bon

8、e erosionnmri：poorly defined margins ；t1wi iso- to hypointense ； t2wi hyperintense；seven vertebral segments； cysts；eccentric； some enhancement 星形細胞瘤星形細胞瘤髓內(nèi)腫瘤髓內(nèi)腫瘤星形細胞瘤星形細胞瘤星形細胞瘤星形細胞瘤星形細胞瘤星形細胞瘤 characteristiccharacteristicependymomaastrocytoma population in which lesions population in which lesions mo

9、st commonly occur most commonly occuradultpediatric location in the spinal canal location in the spinal canalcentraleccentric morphologic appearance morphologic appearancewell circumscribedill defined hemorrhage hemorrhagecommonuncommon enhancement with contrast material enhancement with contrast ma

10、terialf o c a l , i n t e n s e homogeneousp a t c h y , irregular predilection for involvement predilection for involvement of the conus medullaris or filum terminale of the conus medullaris or filum terminaleyesnohemangioblastoma 血管母細胞瘤血管母細胞瘤nthoracic cord (50%), solitary ,younger than 40 ys .nhig

11、hly vascular, discrete, nodular, red-to-orange masses abutting the leptomeninges with prominent dilated and tortuous vessels on the posterior cord surface . syrinx is common imaging characteristics nct : hypoattenuated cystlike massnmri: diffuse cord expansion and variable signal intensity on t1wi,

12、isointense (50% o) or hyperintense (25%); t2wi high signal intensity with intermixed focal flow voids, cyst formation or syringohydromyelia ncystic mass with an enhancing mural nodule 血管母細胞瘤血管母細胞瘤血管母細胞瘤血管母細胞瘤metastasis (轉(zhuǎn)移瘤）轉(zhuǎn)移瘤）nsolitary, two to three vertebral segments, cervical cord nmild cord exp

13、ansion over several segments. t1wi central area of low signal intensity (mimicking a syrinx); t2wi high signal intensity ; ncysts are rare . enhance intensely and homogeneously 轉(zhuǎn)移瘤轉(zhuǎn)移瘤轉(zhuǎn)移瘤轉(zhuǎn)移瘤髓外硬膜下腫瘤脊膜瘤n增強掃描十分重要n可明確腫瘤位于硬膜內(nèi)n可顯示脊膜瘤的特征： 寬基底附著于硬脊膜meningiomameningioma-1meningioma-2神經(jīng)纖維（鞘）瘤n沿神經(jīng)鞘同時存在于椎管內(nèi)外nt2w

14、i高信號n明顯增強n內(nèi)部多有壞死n多發(fā)神經(jīng)纖維瘤神經(jīng)纖維瘤神經(jīng)纖維瘤神經(jīng)纖維瘤神經(jīng)鞘瘤神經(jīng)鞘瘤teratoma其他腫瘤其他腫瘤teratomametastasissubdural cystsacrum canal cyst硬膜外腫瘤n單純硬膜外軟組織腫瘤n椎體腫瘤n椎體并軟組織腫瘤metastasismetastasis-1metastasis-2脊索瘤脊索瘤metastasismetastasismetastasisacidophil granulomamultiple myeloma脊柱先天畸形脊髓脊椎的發(fā)育和解剖神經(jīng)管閉合不全脊柱裂: 隱性;伴脊膜膨出;伴脊髓脊膜膨出 脊柱裂脊柱裂 脊髓栓系脊髓栓系脊脊膜膜膨膨出出脊髓縱裂脊髓縱裂tethered cordtethered cord脊髓空洞癥n鑒別空洞的類型:先天性和繼發(fā)