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不同病理类型脊柱 骨肿瘤的X线、CT及 MRI的影像征象特点 及诊断价值

作者:李 锋1 程天明2

所属单位:1.河南省新乡市中心医院CT室 (河南 新乡 453000) 2.河南省人民医院放射科 (河南 郑州 450000)

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摘要

目的 分析不同病理类型脊柱骨 肿瘤X线、CT、MRI影像征象特点及诊断 价值。方法 回顾性分析2011年3月-2016 年7月我院收治的52例脊柱骨肿瘤患者的 临床资料,所有患者入院后均完成X线、 CT、MRI检查,总结不同病理类型脊柱骨 肿瘤患者影像学特点。结果 ①本组良性 骨肿瘤13例,主要分布于腰椎,其次为颈 椎、胸椎,以血管瘤、纤维结构不良常 见;中间性骨肿瘤15例,主要分布于胸 椎、腰椎,以骨母细胞瘤、骨巨细胞瘤、 朗格汉斯细胞组织细胞增多症多见;恶性 骨肿瘤34例,主要分布于胸椎,其次为腰 椎,以浆细胞骨髓瘤、非霍奇金淋巴瘤常 见。②MRI诊断不同病理类型脊柱骨肿瘤 准确率最高(76.92%、80.00%、83.33%), 其次为CT(61.54%、73.33%、75.00%),其 中MRI诊断整体准确率(80.77%)高于X线 (55.77%)(P<0.05)。结论 MRI对不同病 理类型脊柱骨肿瘤诊断准确率最高,对X 线、CT无法确诊脊柱骨肿瘤可进一步进行 MRI筛查,以减少漏诊,为临床治疗奠定 影像学依据。

Objective To analyze the imaging findings and diagnostic value of X ray, CT and MRI in different pathological types of spinal bone tumors. Methods The clinical data of 52 cases of patients with spinal bone tumors treated in our hospital from March 2011 to July 2016 were retrospectively analyzed. All patients were examined with X-ray, CT and MRI. The imaging findings of patients with different pathological types of spinal bone tumors were summarized. Results ①In the study, there were 13 cases of benign bone tumors, mainly distributed in the lumbar vertebra, then in cervical vertebrae, thoracic vertebra, and hemangiomas and fibrous dysplasia were common. There were 15 cases of intermediate bone tumors, mainly distributed in the thoracic vertebra and lumbar vertebra, and osteoblastoma, giant cell tumor, Langerhans cell histiocytosis were common. There were 34 cases of malignant bone tumors, mainly distributed in the thoracic vertebra, then in lumbar vertebra, and plasma cell myeloma and non-Hodgkin lymphoma were common. ②The accuracy rates of MRI in the diagnosis of different pathological types of spinal bone tumors were the highest (76.92%, 80.00%, 83.33%), followed by CT (61.54%, 73.33%, 75.00%), and the overall diagnostic accuracy of MRI (80.77%) was higher than that of X-ray (55.77%) (P<0.05). Conclusion The accuracy of MRI in the diagnosis of different pathological types of spinal bone tumors is the highest. For spinal bone tumors that can not be diagnosed by X-ray and CT, they can be further screened by MRI to reduce missed diagnosis, provide imaging evidences for clinical treatment.

【关键词】脊柱骨肿瘤;MRI;X线;CT; 病理;诊断

【中图分类号】R44.2;R445.3;R445.4

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2018.04.043

前言

脊柱系人体中轴骨,承担负重、减震、运动等功能,包括颈段、 胸段、腰段、骶段,为骨肿瘤好发部位,约占全身骨肿瘤的6.5%,其 中转移瘤所占比例超过50%[1]。一般大部分良性脊柱骨肿瘤或肿瘤样病 变患者其临床表现为轻微,局部症状不明显,且无特异性全身症状, 以青少年多见,病程较长;而恶性脊柱骨肿瘤患者其发病年龄较大, 成人多发,局部症状严重,且呈进行性加重特点,部分伴全身症状, 患者病程短,病情严重[2]。且原发性脊柱骨肿瘤其病理类型复杂,常 缺乏特异性影像学征象,临床诊断困难,误诊、漏诊率较高[3]。而明 确不同病理类型脊柱骨肿瘤影像学征象,减少误诊、漏诊,则可为患 者诊疗提供有效的影像学依据,有助于改善其预后。基于此,为探讨 不同病理类型脊柱骨肿瘤患者影像学征象及诊断价值,现对收治的52 例患者的临床资料进行了回顾性分析,报道如下。