脊柱肿瘤ppt课件.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 T2WIhyperintensethe capsign 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 SY