颈椎哑铃形肿瘤MRI分型探讨

Investigation of the MRI classification of cervical dumbbell-type tumor

目的探讨颈椎哑铃形肿瘤MRI分型及其意义。方法回顾性分析1998年～2003年颈椎哑铃形肿瘤患者34例。根据患者术前MRI设计颈椎哑铃形肿瘤的MRI分型。将颈椎哑铃形肿瘤按MRI分型设计分为4型，Ⅰ型：肿瘤跨椎间孔生长，主体位于椎管内；Ⅱ型：肿瘤向后方结构破坏性生长；Ⅲ型：肿瘤跨椎间孔生长，主体位于椎管外，其中Ⅲa型为椎动脉被推挤移位但未被肿瘤包绕，Ⅲb型为椎动脉被肿瘤包绕；Ⅳ型：肿瘤侵及前方椎体，其中Ⅳa型为肿瘤侵及椎体〈1／3，Ⅳb型为肿瘤侵及椎体≥1／3。结果依据MRI分型，本组患者中Ⅰ型7例，Ⅱ型9例，Ⅲ型13例，Ⅳ型5例。行单纯扩大后正中入路手术治疗27例，行前后联合入路手术治疗7例。结论颈椎哑铃形肿瘤MRI分型有助于制定有效的外科手术治疗策略。．

Objective To investigate the MRI classification of cervical dumbbell-type tumor and its significance. Methods Thirty-four cases of cervical dumbbell-type tumors from 1998 to 2003 were retrospectively analyzed. According to the manifestation of preoperative MRI, cervical dumbbell-type tumors were categorized into four types ： type Ⅰ（ extending through intervertebral foramen with its main body in the spinal canal）, type Ⅱ（invading to the posterior and destroying the lamina）, type Ⅲ （ extending through intervertebral foramen with its main body beyond the spinal canal） , and type Ⅳ（ involving the vertebral body）. Type Ⅲ tumor could be divided into subtype Ilia （pushing vertebral artery but not circling it） and subtype Ⅲb （circling vertebral artery） , and type Ⅳtumor could also be divided into subtype Ⅳa （involving vertebral body 〈 1/3 ） and subtype IV b （ involving vertebral body 1〉 1/3 ）. Results According to the MRI classification, there were 7 cases of type Ⅰ , 9 type Ⅱ, 13 type Ⅲand 5 type Ⅳ. The extended posterior approach was used in 27 cases, the combined anteroposterior approach in 7 cases. Conclusion The MRI classification of cervical dumbbell-type tumor is helpful to plan optimal surgery.