摘要
目的探讨脊椎骨内神经鞘瘤(Intraosseous Schwannoma,IOS)的特征性影像学表现,以与其他脊椎溶骨性病变区别开。方法回顾性分析上海交通大学医学院附属第九人民医院经手术病理证实的脊椎IOS的临床资料及CT、MRI等影像学资料。该文收集了11例脊椎IOS患者,其中男性7例,女性4例,年龄23~74岁[平均年龄(51±17)岁]。所有患者均行CT和MRI检查。由两名高年资骨关节系统放射科医师对所有影像学征象进行评估,并复习了近几年来文献报告的脊椎IOS影像学征象。结果病变累及部位包括颈椎3例(3/11,27.3%),胸椎1例(1/11,9.1%),腰椎5例(5/11,45.5%),腰骶椎2例(2/11,18.2%),最大径(5.8±2.85)cm,形态均为不规则形。CT显示偏心性膨胀性溶骨性骨质破坏,密度不均匀,平扫CT值为(43.0±11.55)HU。增强后不均匀轻度强化,CT值为(70.3±12.22)HU,病灶边界清晰,有硬化缘,未见骨膜反应,病灶易沿着椎间孔向椎管内外延伸。在MRI上,与肌肉组织相比,病灶在T1WI上呈等稍低信号,在T2WI上呈混杂稍高信号,压脂后呈混杂高信号,DWI未见弥散受限,ADC值为(1.25±0.176)×10-3mm2/s,增强后不均匀明显强化,时间-信号强度曲线为I型,7例患者病灶内发生囊性变。结论脊椎IOS是一种罕见的良性肿瘤,影像学表现具有一定的特征性,在鉴别诊断边界清晰的具有异质性的脊椎溶骨性病变时应予以考虑。
Objective To explore the imaging features of intraosseous schwannoma(IOS)involving the spine in order to differentiate it from other spinal osteolytic lesions.Methods We retrospectively analyzed the clinical data,CT and MRI of IOS involving the spine confirmed by surgery and pathology in Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine.We collected 11 cases of IOS involving the spine,including 7 males and 4 females,aged 23-74 years[average age(51±17)years].All patients underwent CT and MRI examinations.Two senior bone and joint system radiologists evaluated the imaging features and reviewed literatures reported in recent years.Results The IOS involved 3 cases of cervical spine(3/11,27.3%),1 case of thoracic spine(1/11,9.1%),5 cases of lumbar spine(5/11,45.5%),and 2 cases of lumbosacral spine(2/11,18.2%),with a maximum diameter of(5.8±2.85)cm and an irregular shape.CT showed eccentric expansive osteolytic bone destruction with uneven density.The average CT values on plain scan were(43.0±11.55)HU.After enhancement,the lesions showed uneven mild enhancement,with an average CT value of(70.3±12.22)HU.The boundaries of the lesions were clear,with sclerotic edges and no periosteal reaction.The lesions were prone to extend along the intervertebral foramen to the inside and outside of the vertebral canal.On MRI,compared with muscle tissue,the lesions showed equal low signal intensity on T1WI,mixed slightly high signal intensity on T2WI,mixed high signal intensity after fat suppression,and no diffusion limitation on DWI with the average ADC value of 1.25±0.176×10-3mm2/s.After enhancement,the lesions showed uneven and significant enhancement,with a time signal intensity curve(TIC)of type I and cystic changes occurring in 7 lesions.Conclusion IOS involving the spine is a rare benign tumor with certain characteristic imaging features,which should be considered in the differential diagnosis of heterogeneous spinal osteolytic lesions with clear boundaries.
作者
刘玉
王远军
李开成
LIU Yu;WANG Yuanjun;LI Kaicheng(Department of Radiology,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;School of Health Science and Engineering,University of Shanghai for Science and Technology,Shanghai 200093,China)
出处
《生物医学工程学进展》
CAS
2024年第2期136-141,共6页
Progress in Biomedical Engineering
基金
上海市“医苑新星”青年医学人才培养资助计划(沪卫人事〔2021〕99号)
上海理工大学医工交叉项目(2022JK-CZ13Z,2023JK-CZ26Z)
上海交通大学医学院附属第九人民医院2023年度院级教学项目(JYJX03202305)。
关键词
骨内神经鞘瘤
脊椎
计算机断层扫描
核磁共振
Intraosseous Schwannoma(IOS)
Spine
Computed Tomography(CT)
Magnetic Resonance Imaging(MRI)
