可动脊柱骨巨细胞瘤MRI表现与病理对照分析

MRI Appearances of Giant Cell Tumors in the Mobile Spine:Compared with Pathology

目的探讨可动脊柱骨巨细胞瘤MRI表现的病理学基础。方法对21例病理确诊的骨巨细胞瘤MRI表现和病理特点进行回顾性对照分析。结果 T1WI上肿瘤呈低至中等信号(20例)或混杂信号(1例),T2WI较具特征性以等或低信号(11例)为主,骨化、钙化、纤维化和含铁血黄素沉积导致肿瘤信号减低,伴发的囊变、出血、坏死导致肿瘤信号混杂(8例),实质以丰富的单核及多核巨细胞为主,而间质无明显的骨化、钙化、纤维化和含铁血黄素沉积对应肿瘤在T2WI上呈稍高信号(2例);增粗的骨小梁、纤维分隔伴含铁血黄素沉积对应椎体内线样低信号分隔(6例);肿瘤周围反应性纤维组织增生对应肿瘤周围假包膜形成(1例);间质丰富小血管、血窦是肿瘤明显强化的病理学基础,6例强化较均匀,9例内部囊变、坏死明显肿瘤呈不均匀强化,1例间质小血管成分较少,强化不明显。结论可动脊柱骨巨细胞瘤MRI表现具有一定特征性,肿瘤实质和间质比例及成分的多样性是导致肿瘤信号多样的重要因素。

Objective To explore the pathological basis of the magnetic resonance imaging（MRI） features of giant cell tumors （GCTs） in the mobile spine. Methods The MRI images and pathological appearances of 21 patients with GCT were retrospectively reviewed. Results Twenty tumors showed homogeneous low to intermediate signal intensity on T2 WI images and one tumor showed heterogeneous signal intensity on T2 Wi. 11 cases showed iso to low signal intensity on T2 WI. Calcification, bone like matrix, collagen matrix and hemosiderin deposition made low signal intensity. Eight tumors showed heterogeneous signal intensity mainly due to secondary cystic changes, necrosis, and hemorrhage. Abundant mononuclear and multinucleated giant cells without calcification, bone-like matrix , collagen matrix and hemosiderin deposition made tumors as relatively high signal on T2WI. Curvilinear low signal was observed in six cases on T2 WI and T2WI images within the vertebral body,which corresponded to thickened trabeculae, fibrous setae, or hemosiderin deposit. The low-signal-in- tensity pseudocapsu｜e was observed in one tumor due to surrounding fibrous proliferation. Abundant thin walled capillaries , blood sinus were the basement of the enhancement pattern. Contrast enhanced scan showed significant homogeneous en- hancement in six cases and nine cases showed heterogeneous enhancement due to cystic changes, necrosis. One case showed no significant enhancement due to rare thin-walled capillaries in the stroma. Conclusion MRI appearances can reflect the pathological characteristic of GCTs. The proportion of parenchyma and interstitial led to tumor signal diversity.