可动脊柱脊索瘤的CT和MRI征象分析

CT and MRI Features of Mobile Chordoma

目的探讨原发于可动脊柱脊索瘤的CT和MRI的影像表现,以提高术前诊断准确性。方法回顾性分析经手术病理证实的45例原发于可动脊柱脊索瘤的影像学特点。38例行CT及CTA检查,35例行MRI及增强扫描。结果45例可动脊柱脊索瘤中,75.6%位于颈椎,6.7%位于胸椎,17.8%位于腰椎。40例表现为椎体及(或)附件区骨质破坏伴周围软组织肿块,其中31例可见肿块向椎管内突出。CT上,32例表现为溶骨性骨质破坏,30例伴有骨质硬化,21例病变内可见钙化或残留的骨棘。CTA上,20例血管被包绕或推挤而无狭窄或侵犯。MRI上,T_(1)WI示肿瘤表现为混杂低信号(28例),T_(2)WI上表现为混杂高信号(32例),典型者表现为“蜂房样”改变。增强扫描间隔及包膜呈“花环样”轻度至明显程度强化。结论可动脊柱脊索瘤主要位于颈椎,CT和MRI可清楚显示肿瘤的骨质破坏方式、程度及向邻近结构侵袭等生物学行为特征。溶骨性骨质破坏伴骨质硬化及T_(2)WI上“蜂房样”高信号的软组织肿块主要为其典型的影像学表现。

Objective To investigate the CT and MRI features of chordoma primary locating in the mobile spine and improve the preoperative diagnostic accuracy.Methods The imaging characteristics of forty-five patients with primary mobile chordoma proved by surgery and pathology were analyzed retrospectively.38 cases underwent CT and CTA examination,35 cases underwent MRI and enhancement examination.Result Among the 45 cases of mobile chordoma,cervical spine,thoracic spine and lumbar spine were involved accounting for 75.6%,6.7%and 17.8%respectively.Forty patients showed bone destruction in the vertebral body and/or posterior attachment with soft tissue mass,and 31 of them had invaded the intraspinal space.CT showed that 32 cases had lytic bone destruction and 30 cases had osteosclerosis.Calcification or residual bone were seen in 21 cases on CT.The vessels were wrapped or squeezed without stenosis or invasion in 20 cases on CTA.Meanwhile,MRI showed that the T_(1)WI signal intensity was mixed hypointense in 28 cases.The T_(2)WI signal was mixed hyperintense in 32 cases,which showed the typical hallmark“honeycomb”appearance.Slight to significant enhancement was revealed on contrast enhanced scan.Conclusions Chordoma of the mobile spine is commonly located in the cervical spine.The biological behaviors of the tumor,such as the manner,the degree of bone destruction and invasion of adjacent structures,can be clearly delineated on CT and MRI.Osteolytic bone destruction with osteosclerosis and soft tissue mass with the hyper signal“honeycomb”appearance on T_(2)WI are the typical radiographic findings.