可动脊柱原发性骨肉瘤的影像学研究

Imaging analysis of primary osteosarcoma in mobile spine

目的:探讨可动脊柱原发性骨肉瘤的影像学及临床表现。方法:回顾性分析12例经病理证实的可动脊柱原发性骨肉瘤患者的CT、MRI及临床资料。结果:可动脊柱原发性骨肉瘤中位年龄43岁,11例(91.67%)单发;发生于颈椎7例(58.33%),腰椎3例(25%),胸椎2例(16.67%);6例(50%)起源于附件;在CT上,8例(66.67%)呈混合型骨质破坏,1例(8.33%)呈膨胀性骨质破坏,2例(16.67%)呈纯溶骨性骨质破坏,1例(8.33%)呈象牙椎改变;6例(50%)椎体压缩;10例(83.33%)肿瘤骨形成;2例(16.67%)见针状骨膜反应;11例(91.67%)骨质破坏区边界不清晰;CT增强扫描呈2例(40%)中度不均匀强化,3例(60%)重度不均匀强化。在MRI上,10例(90.91%)有椎旁、椎管内侵犯,纵向侵犯范围均超出2个椎体范围。病变在T1WI序列上2例(18.18%)呈等信号、5例(45.46%)低信号、4例(36.36%)等低混杂信号;在T2WI序列3例(27.27%)呈低信号、2例(18.18%)稍高信号、6例(54.55%)高低混杂信号;MRI增强扫描8例(100%)为明显不均匀强化。结论:可动脊柱原发性骨肉瘤的好发于颈椎,多起源于附件,混合型骨质破坏、特征性瘤骨、T2WI低信号、侵犯椎旁及椎管有助于本病的诊断。

Objective:To explore the imaging and clinical findings of primary osteosarcoma of mobile spine(POMS).Methods:Imaging and clinical findings were retrospectively evaluated in 12 cases of POMS,all of which were confirmed pathologically.Results:The median age of POMS is 43 years old.Eleven cases(91.67%)had monostotic POMS.Involvement included cervical(n=7,58.33%),thoracic(n=2,16.67%)and lumbar(n=3,25%)spine.Six patients(50%)arose from the posterior elements.CT scans showed 8 cases(66.67%)had mixed bone destruction,1 case(8.33%)had expansive pattern,2 cases(16.67%)had purely lytic pattern,and 1 case(8.33%)had ivory appearance.Pathologic compression fractures were identified in 6 cases(50%).Ten cases(83.33%)had tumor bone;2 cases(16.67%)had spiculated periosteal reaction;11 cases(91.67%)had obscure boundary;CT enhanced scan showed 40%(n=2)moderately and 60%(n=3)significantly heterogeneous enhancement.MRI showed invasion of the paraspinal tissue and the spinal canal was seen in 10(90.91%)cases,all of which invade more than 2 vertebral bodies longitudinally.On T1WI,2 cases(18.18%)showed intermediate signal,5 cases(45.46%)revealed low signal,and 4 cases(36.36%)presented as heterogeneous signal.On T2WI,3 cases(27.27%)had low signal intensity,2 cases(18.18%)were noted as mildly hyperintensive,and 6 cases(54.55%)presented heterogeneous.Eight cases(100%)had significantly heterogeneous enhancement.Conclusion:POMS mostly involved the cervical spine,and arose from the posterior elements.Mixed bone destruction,typical tumor bone,low signal on the T2WI and invasion of the paravertebral and spinal canal were helpful findings for the diagnosis of POMS.