脊柱侵袭性血管瘤典型影像表现

Typical imaging findings of aggressive vertebral hemangiomas

目的探讨脊柱侵袭性血管瘤影像学表现,提高诊断正确率及降低误诊率。方法选取经手术病理证实的18例侵袭性血管瘤患者,所有患者均已行CT、MRI平扫检查,其中10例行MRI增强检查。分析患者的CT、MRI表现,重点观察图像中是否有椎体血管瘤的典型征象及额外的侵袭性征象,并找出有诊断提示意义的特殊征象。结果18例脊柱侵袭性血管瘤患者中,发生在胸椎者12例(66.7%),腰椎者4例(22.2%),颈椎者1例(5.5%),骶椎者1例(5.5%)。其中16例(88.9%)有椎体血管瘤的典型征象,其中冠矢状位椎体的栅栏样改变4例,椎体横断位圆点征4例。椎体内T 2WI压脂像高信号18例,增强扫描明显强化10例。所有病例(100%)均有侵袭性的征象,其中包括软组织肿块17例,明显的骨皮质破坏中断5例,累及上下椎间盘及椎体3例;其中6例出现了特殊的影像学征象;MRI矢状位压脂像上扁平椎两端的高亮信号呈哑铃状外观2例,MRI横断位软组织肿块爆米花样的改变2例。受侵椎体团块状钙化2例,椎旁软组织肿块内见条状或斑片状骨壳样改变2例。结论大多数侵袭性血管瘤首先有椎体血管瘤的典型征象,在此基础上合并侵袭性的征象,一些病例呈特殊性的外观,这些征象可帮助我们降低误诊率。

Objective To study the typical imaging findings of aggressive vertebral hemangiomas so as to improve the diagnostic accuracy and reduce the misdiagnosis rate.Methods Eighteen patients with aggressive vertebral hemangiomas confirmed by operation and pathology from March 2013 to June 2020 were reviewed.All patients were examined by CT,MRI,and 10 of them were examined by enhanced MRI.We analyzed the CT,MRI findings of the patients,focused on whether there were typical signs and additional invasive signs of vertebral hemangioma,and found out the special signs with diagnostic significance.Results Among the 18 patients with aggressive vertebral hemangiomas,12 cases(66.7%)occurred in thoracic vertebrae,4 cases(22.2%)in lumbar vertebrae,1 case(5.5%)in cervical vertebrae and 1 case(5.5%)in sacral vertebrae.Among them,16 cases(88.9%)had typical signs of vertebral hemangioma,including 4 cases of fence-like change of vertebral body in sagittal position and 4 cases of dot sign in transverse position of vertebral body.T 2WI fat compression images showed hyperintense in 18 cases and obvious enhancement in 10 cases.All cases had invasive signs,including 17 cases of soft tissue mass,5 cases of obvious bone cortical destruction and 3 cases of involvement of upper and lower intervertebral disc and vertebral body,among which 6 cases had special imaging signs,including dumbbell-like appearance of highlight signal at both ends of upper flat vertebra on MRI sagittal position and popcorn-like changes of soft tissue mass in transverse position of MRI.Massive calcification of the invaded vertebrae was found in 2 cases,and striped or patchy bone shell-like changes were seen in the paraspinal soft group in 2 cases.Conclusion Most aggressive vertebral hemangiomas first has the typical signs of vertebral hemangioma.On this basis combined with invasive signs,some cases show a special appearance.These signs can help us reduce the misdiagnosis rate.