脊柱纤维结构不良的影像学特点

Imaging features of spinal fibrous dysplasia

目的 ：探讨脊柱纤维结构不良的影像学特征。方法 ：回顾性分析2004年4月~2014年1月收治的10例经手术病理确诊的脊柱纤维结构不良患者的影像学资料,其中颈椎3例,胸椎4例,腰椎3例。男6例,女4例。所有病例均行X线平片、CT和MRI检查。根据影像学检查结果系统评估病灶部位、范围、基质密度、边界、附件有无受累、受累椎体骨皮质有无破坏,有无软组织肿块。结果：脊柱纤维结构不良X线平片表现为圆形或类圆形囊状低密度影,4例位于胸椎者显示不佳,余6例中5例基质密度均匀,6例边界清晰,所有患者均未见皮质破坏及软组织肿块。CT表现为类圆形低密度影,边界清晰,骨皮质略微变薄但连续性未破坏。基质密度均匀者7例,9例位于椎体内,1例累及附件骨,均未见皮质破坏及软组织肿块。MRI均表现为TIWI中均匀长T1信号,T2WI呈混杂偏低信号,在TIWI、T2WI及T2抑脂像中病灶周围均有较完整的低或极低信号环状带;2例增强扫描时病灶信号轻度强化。结论：脊柱纤维结构不良具有一定的良性瘤样病变的影像学特征,包括基质均匀、边界清晰、明显的硬化缘、无骨皮质破坏和软组织肿块,这些特征有助于诊断和鉴别诊断。

Objectives： To investigate the imaging features of spinal fibrous dysplasia. Methods： Ten patients with the diagnosis of spinal fibrous dysplasia by pathology were retrospectively analyzed from April 2004 to January 2014. The lesion was localized in the cervical vertebra in 3 cases, in the thoracic vertebra in 4 cas-es and in the lumbar vertebra in 3 cases. There were 6 males and 4 females in this group. All patients were evaluated by X-ray, CT and MRI. The lesions were evaluated completely with location, dimension, matrix density, boundary, compromise of appendix of vertebra, cortex destruction and soft tissue mass. Results： The lesion was detected with a round or round-like radiolucent area within the vertebra in radiographs. 4 cases located in the thoracic spine were not displayed. Five cases were found with homogeneous matrix in the le-sion. The boundary of lesion was well demarcated in 6 cases. The cortical destruction and soft tissue mass were not found in all the cases. A round or oval low-density lesion with a demarcated margin between the lesion and normal vertebra was detected in the CT scans. The vertebral cortex was thin but intact. The ho-mogeneous matrix in the lesion was found in 7 cases. The lesion was localized within the vertebra in 9 cas-es. The appendix of vertebra was compromised by the lesion in only one case. There were no cortical de-struction and soft tissue mass detected in all the cases. Homogeneous long T1 signal on T1 WI, hypo- or isointensity and a hypointensity loop surrounded the lesion on T1 WI, T2 WI and T2W1 with fat depression,and focal slight reinforcement on enhanced scanning were indicated in MRI images. Conclusions： Spinal fibrous dysplasia has some typical imaging features similar to tumor-like lesions including homogeneous matrix density, well-demarcated margin with sclerosis, without cortex destruction and without soft tissue mass. These imaging features contribute to the correct diagnosis and differential diagnosis.