《脊柱肿瘤》.ppt

脊柱病变的影像学诊断,山东省医学影像学研究所李传亭,CT脊柱检查,CT脊柱检查,MRI检查脊柱的优势,总体优势：多参数成像多方位成像，尤其矢状断层独特优势：目前唯一能直接显示脊髓内部的影像检查方法,椎间盘病变,椎间盘及椎体的退变椎间盘膨出和脱出从脊柱长轴全面观察以免漏掉其他病变观察突出椎间盘对脊髓或神经根的压迫程度,DEGENERATION,椎间盘变性：SET2GRET2*T1WI椎体终板信号改变：,DEGENERATION,Normal,Post-radiotherapy,DISC-HERNIATION,DISC-HERNIATION,DISC-HERNIATION,DISC-HERNIATION,DISC-HERNIATION,DISC-HERNIATION,椎管狭窄,分型：中心型外围型先天型后天型,颈椎病,DISC-HERNIATION,BASALDEPRESSION,SPINALCANALSTENOSIS,OPLL,脊柱创伤,观察脊髓的受伤程度：水肿、肿胀、出血、断裂、软化观察椎体的状况：有形态改变的骨折无明显形态改变的小梁骨折观察椎管的其他改变：增生、狭窄,脱位:位置错位3.5cm成角11度,TRAUMA,TRAUMA脊髓震荡脊髓受压脊髓挫伤,脊髓损伤,三型:1挫伤伴出血2水肿3混合,TRAUMA,TRAUMA,TRAUMA,椎管肿瘤,髓内肿瘤髓外硬膜下肿瘤硬膜外肿瘤,髓内肿瘤IntramedullarySpinalNeoplasms,Ependymoma(室管膜瘤),Themostcommonintramedullaryspinalneoplasminadults,60%,38.8,maleCervicalcordalonetheupperthoracicregion.MyxopapillaryependymomaDurationofsymptomswas36.5monthsBackorneckpain(67%),sensorydeficits(52%),motorweakness(46%),ImagingCharacteristics,CTX-ray:scoliosisorcanalwideningwithassociatedvertebralbodyscalloping,pedicleerosion,orlaminarthinningMRI:T1WIiso-orhypointense;T2WIhyperintensethecapsign,arimofextremehypointensity(seenatthepolesofthetumoronT2WI.cordedema.3.6vertebralsegments;Cystsareacommon,SyringohydromyeliaWellcontrast-enhanced,室管膜瘤,髓内肿瘤,室管膜瘤,室管膜瘤,Astrocytoma(星形细胞瘤),One-thirdofallspinalcordgliomas；Male；29years；thoraciccord(67%),cervicalcord(49%)；Involvementoftheentirespinalcord；rarefilumterminale；rarelyexophytic.Painandsensorydeficits；Motordysfunction.Youngchildren,withamediandurationof5months.,PathologicCharacteristics,Ill-defineddiffusefusiformenlargement.Tumorcysts(eccentric,smaller,andirregular)andsyrinxesarecommonHypercellularityandtheabsenceofasurroundingcapsuleEnlarged,irregularlyshaped,hyperchromaticnuclei,WHOclassification,GradeI：pilocyticastrocytomas75%GradeII：fibrillarytypeGradeIII：anaplasticastrocytomas25%GradeIV：glioblastomamultiformedistinctlyuncommon,GradeII,GradeIV,ImagingCharacteristics,CT、X-ray：mildscoliosis,widenedinterpediculardistance,andboneerosionMRI：poorlydefinedmargins；T1WIiso-tohypointense；T2WIhyperintense；sevenvertebralsegments；Cysts；eccentric；someenhancement,星形细胞瘤,髓内肿瘤,星形细胞瘤,星形细胞瘤,星形细胞瘤,Hemangioblastoma血管母细胞瘤,Thoraciccord(50%),solitary,youngerthan40ys.Highlyvascular,discrete,nodular,red-to-orangemassesabuttingtheleptomeningeswithprominentdilatedandtortuousvesselsontheposteriorcordsurface.Syrinxiscommon,ImagingCharacteristics,CT:hypoattenuatedcystlikemassMRI:diffusecordexpansionandvariablesignalintensityonT1WI,isointense(50%o)orhyperintense(25%);T2WIhighsignalintensitywithintermixedfocalflowvoids,cystformationorsyringohydromyeliacysticmasswithanenhancingmuralnodule,血管母细胞瘤,血管母细胞瘤,Metastasis(转移瘤）,Solitary,twotothreevertebralsegments,cervicalcordmildcordexpansionoverseveralsegments.T1WIcentralareaoflowsignalintensity(mimickingasyrinx);T2WIhighsignalintensity;Cystsarerare.Enhanceintenselyandhomogeneously,转移瘤,转移瘤,髓外硬膜下肿瘤,脊膜瘤增强扫描十分重要可明确肿瘤位于硬膜内可显示脊膜瘤的特征：宽基底附着于硬脊膜,MENINGIOMA,MENINGIOMA-1,MENINGIOMA-2,神经纤维（鞘）瘤,沿神经鞘同时存在于椎管内外T2WI高信号明显增强内部多有坏死多发,神经纤维瘤,神经纤维瘤,神经鞘瘤,TERATOMA,其他肿瘤,TERATOMA,METASTASIS,SUBDURALCYST,SACRUMCANALCYST,硬膜外肿瘤,单纯硬膜外软组织肿瘤椎体肿瘤椎体并软组织肿瘤,METASTASIS,METASTASIS-1,METASTASIS-2,脊索瘤,脊索瘤,METASTASIS,METASTASIS,METASTASIS,ACIDOPHILGRANULOMA,MULTIPLEMYELOMA,脊柱先天畸形,脊髓脊椎的发育和解剖神经管闭合不全脊柱裂:隐性;伴脊膜膨出;伴脊髓脊膜膨出,脊柱裂脊髓栓系,脊膜膨出,脊髓纵裂,TETHEREDCORD,TETHEREDCORD,脊髓空洞症,鉴别空洞的类型:先天性和继发性空洞和积水确认累及范围,SYRINGOMYELIA,SYRINGOMYELIA,SYRINGOMYELIA,S