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脊索瘤的多层螺旋CT和MRI影像表现分析

作者:徐海滨 王学淳 张 庆

所属单位:山东省青岛市市立医院放射科(山东 青岛 266071)

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摘要

目的 总结脊索瘤的多层螺旋CT 和MRI影像表现。方法 选择我院2010年1 月-2016年3月所收治的脊索瘤患者34例作 为研究对象。行螺旋CT与MRI检查,对患 者多层螺旋CT和MRI影像表现进行总结。 结果 脊索瘤患者好发部位为颅底与骶尾 部,呈不规则分叶状、椭圆状或结节状。 CT检查呈不均匀低密度影或低及等密度 影,边界清晰,均可见溶骨性及膨胀性骨 质破坏,部分可见脊索瘤内点状或斑片状 钙化,增强后呈不均匀轻、中度强化。 MRI平扫示肿瘤轮廓光整、边缘清晰, T1WI均呈均匀或混杂的低或等信号,T2WI 呈明显高信号或等或稍长T2信号,DWI等 或高信号,增强扫描呈“颗粒样”轻、中 度强化。结论 CT利于显示脊索瘤骨质破 坏及瘤内钙化,MRI软组织分辨率高,可 显示病灶内囊变、出血、钙化等多种病理 改变,二者各有优势与不足,在脊索瘤临 床诊断中的应用均有较高价值。

Objective To summarize the multislice spiral CT and MRI findings of chordoma. Methods 34 patients with chordoma who were admitted in our hospital between January 2010 and March 2016 were selected as the study object. Spiral CT and MRI examination were performed and the multi-slice spiral CT and MRI findings were summarized. Results The predilection sites of patients with chordoma were skull base and sacrococcygeal region, irregular lobulated, elliptical or nodular. CT examination showed inhomogeneous low density shadow or low and equal density shadow, with clear boundary, osteolytic and expansive bone destruction, partially visible punctate or patchy calcification in chordoma. After enhanced scan, there were inhomogeneous and moderate enhancement. MRI plain scan showed that the tumors were smooth outline, clear edge, homogeneous or mixed low or equal signal on T1WI, obviously high signal or equal signal on T2WI,and equal or high signal on DWI. Ehanced scan showed particlelike light and moderate enhancement. Conclusion CT is good for the display of bone destruction and tumor calcification in chordoma. MRI has resolution to high soft tissues, which can display lesions with cystic degeneration, hemorrhage, calcification and other pathological changes. Each of them has its advantages and disadvantages. Both of them are of relatively higher value in the clinical diagnosis of chordoma.

【关键词】脊索瘤;颅底;骶尾部;CT

【中图分类号】R445.3;R739.4

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.10.011

前言

脊索瘤为临床少见骨原发性恶性肿瘤,起源于残存的胚胎脊索或 异位脊索,以颅底斜坡、骶尾骨为常见发病部位,所占比例约在35%及 30%左右。已有文献显示[1],脊索瘤的发病人群以老年人为主,且男性 发病率明显高于女性。脊索瘤具有明显局部侵犯性,其中颅底脊索瘤 往往呈破骨侵袭性生长,在原发颅内肿瘤中占0.2%~5.0%[2]。由于脊 索瘤缺乏特异性临床表现,且发病率极低,仅为0.8/10万,因而容易 误诊、漏诊,对患者手术决策及预后造成较大不利影响。大量研究显 示[3-5],由于延误手术实际等因素影响,目前脊索瘤手术治疗的术后复 发率高达65%~85%,CT与MRI均可良好显示脊索瘤部位、大小及与周围 组织关系,可进行有效诊断。本研究以我院收治脊索瘤患者为例,对 多层螺旋CT和MRI影像表现进行总结,以期为脊索瘤的临床诊断提供参 考,现报道如下。