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目的探讨伴有压缩改变的脊椎骨巨细胞瘤的影像学表现。方法回顾分析63例经穿刺或手术病理证实的伴有压缩改变的脊椎骨巨细胞瘤的X线、CT及MRI表现。结果 63例中43例伴有压缩改变(68.3%),共计43个病灶,均表现为溶骨性骨质破坏。局限于单一椎体病灶34个(79.1%),累及邻近椎体病灶9个(20.9%)。按椎体压缩程度分为轻、中、重三组。轻度压缩组24例,95.8%的病灶呈明显膨胀性改变,87.5%的病灶可见残存骨嵴;中度压缩组7例,85.7%的病灶呈轻度膨胀性改变,所有病灶(100%)均可见残存骨嵴;重度压缩组12例,67.7%的病灶可见膨胀性改变,33.3%的病灶可见残存骨嵴。轻中度压缩组以椎体膨胀性改变为主,重度压缩以附件膨胀性改变为主。各组间膨胀性改变无明显统计学差异(P>0.05),而骨嵴及椎旁软组织肿块出现的几率各组间差异有统计学意义(P<0.05)。MRI表现为肿瘤实性成分在T1WI呈低-等信号,T2WI呈等信号,46.9%可见囊变,18.8%可见液-液平面。结论脊柱骨巨细胞瘤在椎体轻度或中度压缩时椎体膨胀性改变及骨嵴较明显;在椎体明显压缩时附件膨胀性改变结合椎旁软组织肿块MR信号特点有助于诊断。
Objective To investigate the imaging findings of giant cell tumor of the vertebra with compression changes. Methods The X - ray, CT and MRI findings of 63 cases of giant cell tumor of vertebrae with compressive changes confirmed by puncture or pathology were retrospectively analyzed. Results 43 of 63 cases were accompanied by compression change (68.3%), a total of 43 lesions, all showed osteolytic bone destruction. Thirty-four lesions (79.1%) were localized to a single vertebral body lesion and nine (20.9%) to adjacent vertebral lesions. According to the degree of vertebral compression is divided into light, medium and heavy three groups. In mild compression group, there were 24 cases, 95.8% of the lesions showed obvious swelling changes, 87.5% of the lesions showed residual bone ridge; 7 cases of moderate compression group, 85.7% of the lesions showed mild expansion, all lesions (100% All the remaining crests were observed. In severe compression group, 12 cases showed dilatancy in 67.7% of the lesions and 33.3% of the lesions showed residual bone ridges. Light to moderate compression group to expand the main vertebral expansion, severe compression to Annex expansion mainly. There was no significant difference in the dilatancy between groups (P> 0.05), but there was a significant difference between the two groups (P <0.05). The MRI showed that the solid components of tumor showed low - equal signal on T1WI, equal signal on T2WI, cystic change 46.9% and liquid - liquid level 18.8%. Conclusions The giant cell tumor of vertebral body changes the vertebral body dilatation and the bone ridge more obviously when the vertebral body is compressed in mild or moderate degree. It is helpful for the diagnosis of the giant cell tumor of the spine when the swelling of the appendix is accompanied by the dilatation of appendix and MR signal of paravertebral soft tissue mass.