椎管内神经鞘瘤的MRI诊断

The diagnosis of neurilemmoma in vertebral canal with MR Imaging (MRI)

目的 分析椎管内神经鞘瘤的MRI表现,提高鉴别诊断能力。方法 27例椎管内神经鞘瘤术前均行MRI平扫+增强检查,并将诊断结果与手术病理对照。结果 肿瘤均单发,良性25例,恶性2例。良性包膜均完整;18例硬膜内生长的良性肿瘤呈长圆形或结节状,7例跨硬脊膜生长而呈类哑铃形,其中6例良性者伴椎管骨质压迫吸收,5例见T_1WI及T_2WI均呈低信号的硬化带。恶性者包膜欠完整,椎管骨质显著破坏;1例椎旁软组织广泛侵犯。T_1WI肿瘤呈低或等信号(较脊髓),T_2WI呈高信号,增强后显著强化;12例瘤内伴囊变,囊变区近似脑脊液信号,4例出血,多呈高信号,增强后均不强化。27例肿瘤病理均无钙化,囊变情况术前均正确提示,MRI对椎管内神经鞘瘤定位诊断符合率100％(27/27),定性诊断符合率88.9％(24/27)。结论 椎管内神经鞘瘤的MRI表现有一定的特征性,MRI是诊断椎管神经鞘瘤的有效手段,对术前指导有较大价值。

Objective To analyze the MRI features of the neurilemmoma and to improve diagnostic accuracy. Methods Neurilemmoma of 27 cases comformed by pathology were studied with MRI. Results Whole of the patients had solitary mass. 25 cases were benign 2cases were malignant. The features of the benign showed entire caplus; 18 cases showing long and circle shape were located at the spinal duramater,7 cases showing dumbbell shape growed into the intervertebral foramen, the oppressed absorption of vertebral bone in 6 cases, and the outstanding bone hard belt with the low signal on T1WI and T2WI. The features of the malignant showed the irregular caplus, the seriously destructed vertebra, and the defused invasion of para spinal soft tissue. There were not calcify in 27cases. the material part in the neurilemmoma appeared low signal on T1WI, high signal on T2WI,and the significant enhancement after injection of Gd - DTPA on T1WI.The cystic areas in 12 appeared the quasi signal to ncurolymph. The hemorrhage areas in 4 appeared high signal on T1WI and T2WI, and in those areas no enhancement was found on T1WI,the cyst and material com-ponts in the tumor were all impressed before operation. The MRI coincidence rate in location diagnosis was 100% , and that in nature diagnosis 88. 9% . Conclusion MRI is relative specificity for neurilemmoma of verterbral cannal.