脊柱原发原始神经外胚层瘤的MRI诊断

MRI Diagnosis of Primitive Primordial Neuroectodermal Tumors of The Spine

目的回顾性分析脊柱原发原始神经外胚层瘤（PNET）的MRI表现特征,以提高对该病的认识及诊断。方法搜集经病理证实的PNET患者20例,男15例,女5例,年龄3~71岁,中位年龄22.5岁。20例患者术前均行MRI平扫及/或增强扫描。结果 20例PNET患者中,病变位于胸段6例,胸腰交界区1例,腰段5例,腰骶段交界区2例,骶尾椎6例（其中1例伴胸腰段椎管内多发转移）。MRI平扫示病变主要发生在椎管内脊髓外硬膜下、椎管硬膜外、椎体,累及2~5个椎体节段不等,以累及2~3个节段多见。胸腰段病例几乎均沿一侧或双侧椎间孔向椎管外生长,并于附件区或椎旁形成大小不等的软组织肿块,呈等/稍长T_1等/稍长T_2信号,信号不均匀。20例中,14例病变累及椎体,其中,6例受累椎体形态失常,多表现为上下径不同程度变短或前后径增长;2例椎体呈双凹状;1例呈铜板样改变。增强扫描病变呈中度或明显不均匀强化,而发生于胸段病变常伴有病变邻近上下段硬脊膜增厚并强化,位于腰骶段病变未见此征象。结论 MRI对PNET的诊断具有一定的影像学价值,可为该病的临床诊断、治疗提供一定的影像学指导价值。

Objective We retrospectively analyzed the MRI features of the primary primitive neuroectodermal tumors of the spine,to improve the understanding and diagnosis of the disease. Methods 20 cases of primitive neuroectodermal tumors confirmed by pathology were collected from June 2011 to November 2016 in our hospital,15 males and 5 females,aged 3-71,22. 5 of median age. Results 6 cases of lesions in the thoracic,1 case of thoracic and lumbar border area,5 cases of lumbar,2 cases of lumbosacral segment border,6 cases of sacral vertebrae（ One case with thoracolumbar multiple metastasis in spinal canal） in all the 20 cases of PNET patients. It showed lesions mainly in the spinal epidural subdural,spinal epidural and vertebral body,involving 2-5 vertebral segments,more involving 2-3 segments in MRI scan. The thoracolumbar cases almost all grow along the one or both intervertebral foramen to the extraspinal canal,and soft tissue masses of different sizes are formed in the attachment area or the paravertebral,showing equal/slightly long T_1/slightly T_2 signals,and the signal is heterogeneous. 14 cases involving the vertebral body,in which 6 cases of vertebral body deformity,and showed varying degrees of shortening in the upper and lower diameter or increased in the anteroposterior diameter; 2 cases of vertebral body was concave; 1 case of copper plate-like changes. After the contrast agent was injected,the lesion displayed moderate or obvious heterogeneous enhancement,and occurred in the thoracic lesions often accompanied by thickening and enhancement of spinal cord in the lesions adjacent to the upper and lower segments,and did not show this sign of lesions located in the lumbosacral. Conclusion MRI has certain imaging value diagnosis in PNET,and it can provide a certain degree of imaging guidance in the clinical diagnosis and treatment of the disease.