椎管内髓外硬膜下肿瘤MRI诊断与临床病理对照研究

The Clinical-Pathological Comparative Study in the Diagnosis of Intradural-Extramedulary Tumors with MRI

目的评价MRI对椎管内髓外硬膜下肿瘤诊断和鉴别诊断的价值和限度。方法 分析行MRI检查和临床病理证实的艇外硬膜下肿瘤62例,分别观察神经鞘瘤、神经纤维瘤、脊膜瘤、胚胎类肿瘤的发病性别、年龄、部位、大小、向椎间孔延伸情况及信号强度和强化情况。结果 脊膜瘤多见于40岁以上女性胸段椎管内,瘤体较小,极少向椎间孔延伸,在T1 WI,T2WI上均为均匀等信号,有明显均匀强化,无囊变坏死,可有脊膜尾征;胚胎类肿瘤发病率低,好发于胸腰段,呈混杂信号;神经鞘瘤以增强扫描环状强化可与神经纤维瘤鉴别。结论MRI平扫和增强扫描对肿瘤的定位诊断准确可靠,对大部分肿瘤定性诊断准确,为诊断椎管内肿瘤的首选检查方法。

Objective To explore the value and limit of magnetic resonance imaging (MRI) for diagnosis and differentiation in intraspinal intradural-extramedulary tumors. Methods 62 cases of intradural-extramedulary tumors proved by clinic and/or histopathology were analyzed retrospectively. All cases examined with MRI were divided into 4 groups according to pathological type, meningiomas, neurinomas, neurofibromas and embryonal tumours. The age and sexuality of patient, the size and extension of the tumors to intervertebral foramen, the signal intensity, the degree and type of enhancement were compared each other. Results The position of meningiomas was mostly in thoracic intraspine of female over 40 years old. The focus of meningiomas was small and seldom extended to intervertebral foramen. The signal intensity of meningiomas was homogeneously equal to the spinal cord on T1 WI and T2 WI mostly. The enhancement on meningiomas was remarkable and homogeneous and sometime with dural tail sign. Embryonal tumour lay mostly in the thoracolumbar intraspine and showed specific signal because of fat and calcification. Neurinomas could be differentiated from neurofibromas according to its ring-shaped enhancement. Conclusion MRI is accurate in all localization of tumors and the majority of characterization and is the most valuable and first-selected method for diagnosing intraspinal tumors.