神经鞘瘤伴脊柱骨破坏的影像表现

The imaging appearances of Schwannomas with spinal bone destruction

目的:探讨神经鞘瘤伴脊柱骨破坏的影像表现,提高对此肿瘤的认识。方法:回顾分析9例经病理证实、伴脊柱骨破坏的神经鞘瘤,分析CT和MRI影像表现。结果:3例位于颈椎,4例位于胸椎,2例位于腰骶椎。肿瘤边界均比较清晰、呈分叶状、肿瘤体积大小差异较大,腰骶段肿瘤体积较颈胸椎者大。CT显示8例均表现为椎体和或附件骨质膨胀性骨破坏,3例肿瘤内可见残存骨嵴、2例可见硬化边,肿瘤均无完整骨壳;位于颈胸段者4例伴椎间孔扩大,位于腰骶段2例均伴骶孔扩大;MRI显示肿瘤在T1WI表现为等或稍低信号,T2WI信号不均匀,呈混杂信号;增强扫描肿瘤呈不均匀强化。结论:伴明显脊柱骨侵犯的神经鞘瘤少见,CT和MRI影像学表现具有一定特征性。肿瘤呈分叶状、以膨胀性、溶骨性骨质破坏为主。T2WI信号混杂,增强扫描呈不均匀强化。

Objective： To explore the imaging appearances of Schwannomas with spinal bone destruction and raise the awareness of this tumor. Methods： CT and MRI of 9 cases pathologically confirmed Schwannomas with spinal bone destruction were analyzed retrospectively. Results： Among the 9 cases, 3 cases were located in cervical vertebrae, 4 cases were located in thoracic vertebrae, and 2 cases were located in lumbosacral vertebrae. The boundary of tumors was relatively clear, with lobu lated edge. The tumors located in lumbosacral segment were larger than those in cervical thoracic segment. Eight cases were manifested as expanding osteolytic destruction. Remnants of bone crest could be seen in 3 cases. Two cases had sclerotic rims. None had complete bone shell. The intervertebral foramen and sacral foramen were expanded in 4 cases located in cer vical and thoracic segment and all cases in the lumbosacral segment. T1-weighted MRI revealed that tumors had homogeneous and low to intermediate signal intensity. The tumors showed heterogeneous signal intensity on T2WI, and demonstrated signifi cant heterogeneous enhancement on post-contrast images. Conclusions： Schwannomas with spinal bone destruction are rare. The imaging appearances of schwannomas are characteristic on CT and MRI. The tumors are lobulated, with expanding oste olytic bone destruction. The signal of tumor is heterogeneous and significant heterogeneous enhancement can be seen on post contrast images.