脊柱软骨肉瘤的影像表现及少见表现探讨

Imaging manifestations and unusual presentation of spinal chondrosarcoma

目的:探讨脊柱软骨肉瘤的CT和MRI影像表现,以提高对该肿瘤的认识。方法:对33例经病理证实的脊柱软骨肉瘤的影像表现与病理结果进行对照分析,探讨分析其影像表现。结果:脊柱软骨肉瘤患者共33例,其中男17例,女16例,平均年龄(41.4±11.6)岁。颈胸椎、腰椎及骶椎分别为25例、5例和3例,分别占75.8%、15.2%和3%。病变位于脊柱、脊柱旁和椎管内的分别为22例、9例和2例,分别占66.7%、27.3%和6%。19例可见骨破坏,14例骨破坏不明显,分别占57.6%和42.4%。骨破坏位于椎体、附件、椎体和附件均累及的分别占15.1%、27.3%、42.4%。15例肿瘤呈外生性生长,占45.5%,29例合并椎旁软组织肿块。15例骨破坏程度与软组织肿块不成比例。24例肿瘤伴钙化,钙化形态多样,呈点状(9例,37.5%)、环状(2例,8%)或不规则形(13例,54.1%)。病理检查结果显示普通型26例、间叶型5例、透明型1例、去分化型1例。结论:脊柱软骨肉瘤主要位于颈胸椎,腰骶椎少见;伴或不伴骨破坏;肿瘤以椎体和附件均累及多见,位于椎体及椎管内的少见,肿瘤可呈外生性生长,椎旁软组织肿块及钙化的多见。

Objective:To explore CT and MRI findings of spinal chondrosarcoma and to improve the understanding of this tumor.Methods:The imaging findings of 33 cases of chondrosarcoma of spine confirmed by clinical and pathological examination were analyzed and compared with the pathological results.Results:There were 33 cases of chondrosarcoma of the spine including 17 males and 16 females,with an average age of 41.4±11.6 years.Twenty-five cases,5 cases and 3 cases were located in cervicothoracic spine,lumbar spine and sacrum spine,accounting for 75.8%,15.2%and 3%respectively.Twenty-two cases,9 cases and 2 cases were located in spine,paraspinal and intraspinal region,accounting for 66.7%,27.3%and 6%respectively.Bone destruction was seen in 19 cases,but not in 14 cases,accounting for 57.6%and 42.4%respectively.The bone destruction was located in vertebral body,attachment and both of them,accounting for 15.1%,27.3%,42.4%respectively.Fifteen cases of tumor showed exogenous growth,accounting for 45.5%,29 cases with paravertebral soft tissue mass.Fifteen cases of bone destruction were not in proportion to the soft tissue mass.Calcification was seen in 24 tumors,with various calcifications including punctate(9 cases,37.5%),annular(2 cases,8%)and irrgular(13 cases,54.1%).Pathological resuts showed that 26 cases were common type,5 cases were mesenchymal type,1 case was transparent type and 1 case was dedifferentiated type.Conclusions:Chondrosarcoma of spine is mainly located in the cervicothoracic vertebra,rarely located in the lumbosacral vertebra,with or without bone destruction.Bone destruction is mostly involved in both vertebral body and attachment,tumors are rarely located in vertebral body and spinal canal.The tumor can be exogenous growth,and the paravertebral soft tissue masses and calcification are common.