脊柱血管瘤经皮椎体成形术术前磁共振影像学征象分析评估

Preoperative MRI evaluation of vertebral hemangiomas treated with percutaneous vertebroplasty

目的探讨脊柱血管瘤经皮椎体成形术(PVP)治疗前的MR影像学征象。方法回顾性分析在脊柱MRI检查中发现的286例脊柱血管瘤(VH)患者的年龄,血管瘤发生部位、大小及数目、临床症状及MRI表现。结果 286例(336个)VH中,腰椎(43.15%)和胸椎(37.80%)发病率最高,50～59岁所占比率最高(34.62%),平均直径14.56 mm,单发者占85.66%,2个血管瘤同时发生者占10.14%。其中12例(4.20%)表现为单纯的相应椎体疼痛,2例(0.70%)出现脊髓受压症状。侵袭性血管瘤MRI呈T1W等低、T2W压脂高信号。4例行单纯PVP治疗,2例侵袭性VH行肿瘤部分切除联合PVP治疗。结论 VH的PVP术前MRI评估有助于指导治疗方案的选择。

Objective To discuss the clinical value of preoperative magnetic resonance imaging examination in guiding the treatment of vertebral hemangiomas with percutaneous vertebroplasty（PVP）.Methods A total of 286 patients with vertebral hemangiomas detected on spine MRI in authors＇ Department were enrolled in this study.The patient＇s age,the lesion＇s size and location,the clinical symptoms,MRI findings,etc.were retrospectively analyzed.Results A total of 336 vertebral bodies were affected in 286 patients.The lesions were mainly located at the lumbar spine（43.15%） and the thoracic spine（37.80%）.The highest incidence of disease was seen in 50-59 years old patients（34.62%）.The mean diameter of the lesions was 14.56 mm.Solitary lesion was seen in 85.66% of patients,while two vertebral bodies involved were seen in 10.14% of patients.Twelve cases（4.20%） simply presented as back pain at the related vertebral bodies.Two patients showed signs due to spinal cord compression.All aggressive vertebral hemangiomas were manifested as iso-lower signal on T1-weighted images and higher signal on T2-weighted images.Simple PVP was performed in 4 cases,and subtotal tumor excision together with PVP was carried out in two patients with aggressive vertebral hemangiomas.Conclusion Evaluation of vertebral hemangiomas with MRI performed prior to percutaneous vertebroplasty is very helpful in guiding the selection of therapeutic scheme.（J Intervent Radiol,2012,21： 45-49）