脊柱骨肿瘤的X线、CT及MRI的影像征象分析

Imaging Signs of X-ray, CT and MRI for Spinal Tumors

目的探讨脊柱骨肿瘤的X线、CT及MRI影像学征象。方法回顾分析94例脊柱骨肿瘤患者影像学资料,所有患者均进行X线、MRI检查,88例行CT检查,患者均进行病理学检查,收集患者上述资料,分别比较X线、CT及MRI的影像学特征与病理结果,判断脊柱骨肿瘤患者X线、CT及MRI诊断效能及成像特征。结果 22例患者单发恶性肿瘤,37例多发肿瘤(伴转移性肿瘤患者),共100个恶性肿瘤,122处肿瘤病变部位,其中发生在颈椎为11.5%,胸椎为33.6%,腰椎34.4%,骶尾椎20.5%;其中X线对骨质增生、硬化及骨膜反应成像较佳,CT对软组织肿块、骨质增生、硬化及骨髓水肿成像较佳,MRI对软组织肿块、骨髓水肿成像优于X线、CT;其中X线诊断恶性肿瘤的灵敏度为86.4%,均低于CT、MRI 93.0%、95.0%;脊柱恶性肿瘤多呈溶骨性破坏,或溶骨与成骨混合性存在,X线对不同肿瘤的骨质有不同检出率,而CT、MRI均能有效判断肿瘤对骨质的影响程度。结论脊柱骨肿瘤中转移性骨肿瘤发生率较高,多数具有明显特征的影像学表现,且CT、MRI较X线对恶性肿瘤的敏感性较高,有关临床诊断还需结合患者既往史及病理检查结果。

Objective To investigate imaging signs of X-ray, CT and MRI for spinal tumors. Methods Imaging data of 94 patients with spinal tumors were retrospectively analyzed. All patients underwent X-ray and MRI examination, and 88 patients underwent CT examination. All patients underwent pathological examination, and the above data were collected. The imaging features and pathological results of X-ray, CT and MRI were compared to determine the diagnostic efficiency and imaging features of X-ray, CT and MRI for spinal tumors. Results There were 22 cases with solitary malignant tumors and 37 cases with multiple tumors（with metastatic tumors）. There were a total of 100 cases with malignant tumors and 122 tumor sites, including 11.5% in the cervical spine, 33.6% in the thoracic spine, 34.4% in the lumbar spine and 20.5% in the sacrococcygeal vertebrae. Images of X-ray for hyperosteogeny, sclerosis and periosteal reaction were relatively better. Images of CT for soft tissue mass, hyperosteogeny, sclerosis and bone marrow edema were relatively better, and images of MRI for soft tissue mass and bone marrow edema were better than those of X-ray or CT. The sensitivity of X-ray in the diagnosis of malignant tumors（86.4%） was lower than that of CT or MRI（93.0%, 95.0%）. Malignant spinal tumors showed osteolytic destruction or osteolysis mixed with osteogenesis. The detection rates of X-ray were different for bone quality of different tumors, while CT and MRI could effectively judge the influence on bone quality. Conclusion The incidence of metastatic tumors in spinal tumors is high, and most of them have obvious imaging findings. The sensitivity of CT or MRI is higher than that of X-ray for malignant tumors. Clinical diagnosis should be made combined with past history and pathological examination.