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髓外硬膜外肿瘤的 MRI诊断分析

作者:赵宏伟 祝 佳 张 健

所属单位:中国人民解放军第159中心医院医 学影像科 (河南 驻马店 463000)

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摘要

目的 总结髓外硬膜外肿瘤的MRI 影像学特点。方法 收集我院收治的接受 MRI检查且经手术病理证实的42例髓外硬 膜外肿瘤患者,回顾性分析其MRI表现特 点。结果 转移瘤MRI可见长T1、长T2异常 信号,抑脂序列高信号,增强扫描中度或 明显强化;cobb综合征表现为T1WI等信 号,T2WI稍高信号,抑脂序列明显高信 号,增强扫描附件、椎体、椎管内病灶不 均匀强化,病灶内有迂回、流空血管影; 淋巴瘤表现为T1WI等信号或低信号,T2WI 高信号,增强扫描明显、均匀强化,有 “围管”征;骨髓瘤呈长T1、长T2异常信 号,抑脂序列呈高信号;骨肉瘤T1WI呈不 均匀低信号,T2WI呈不均匀高信号,增强 扫描明显强化;神经源性肿瘤MRI T1WI呈 等信号,T2WI略高信号,脊髓受压移位明 显,分界清晰;恶性小圆细胞瘤T1WI呈等 高信号,T2WI呈等脊髓信号,病灶中心可 见小囊状T1、T2信号,增强呈明显均匀强 化。结论 MRI信号、周围软组织改变、增 强扫描强化程度均可作为髓外硬膜外肿瘤 诊断的重要参考依据。

Objective To summarize the MRI findings of extramedullary epidural tumors. Methods Forty-two patients with extramedullary epidural tumors confirmed by surgery and pathology who underwent MRI examination in our hospital were collected. The MRI findings were retrospectively analyzed. Results MRI of metastasis tumors showed long T1 and T2 abnormal signal, high signal on anti-fat sequence, enhanced scan in moderate or obvious enhancement. MRI of Cobb syndrome showed equal signal on T1WI, slightly higher signal on T2WI and obviously high signal on anti-fat T2WI. Enhanced scan showed that there was inhomogeneous enhancement in adnexa, vertebrae and spinal lesions. There were circuitous and flow void vascular shadows. MRI of lymphoma showed equal or low signal and high signal on T2WI. Enhanced scan showed obvious and homogeneous enhancement, with periductal sign; MRI of myeloma showed long T1 and long T2 abnormal signal, high signal on anti-fat T2WI. MRI of osteosarcoma showed inhomogeneous low signal on T1WI and inhomogeneous high signal on T2WI and enhanced scan showed obvious enhancement. MRI of neurogenic tumors showed equal signal on T1WI, slightly higher signal on T2WI, obvious shift of spinal for compression and clear boundaries. MRI of malignant small round cell tumor showed high signal on T1WI, equal spinal cord signal on T2WI, follicular T1 and T2 signal in lesions and enhanced scan showed obvious homogeneous enhancement. Conclusion MRI signal, changes of peripheral soft tissue and enhancement degree of enhanced scan can be used as an important reference for the diagnosis of extramedullary epidural tumors.

【关键词】MRI;髓外硬膜外肿瘤;诊 断;征象

【中图分类号】R445.2

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.08.029

前言

髓外硬膜外肿瘤为椎管常见肿瘤,以淋巴瘤、转移瘤为主,常见 于中老年群体,病情进展快,常伴疼痛感感,患者多有脊髓压迫症, 累及胸椎、腰椎,表现为神经根、脊髓受压,随后可能出现下肢感 觉、运动功能障碍,或伴括约肌功能失调[1]。MRI是目前诊断髓外硬膜 外病变的有效方案,有较高的软组织分辨率,可实现多参数成像,清 晰显示椎旁结构、脊椎病变及侵犯状况,筛查价值高[2]。但较多研究 者均认为髓外硬膜外肿瘤影像学表现复杂[3]。为进一步分析髓外硬膜 外肿瘤的MRI影像学特点,我院对收治的42例患者的临床资料进行了回 顾性分析,总结报道如下。