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1、Central Nervous System,南京医科大学一附院放射科 洪汛宁 ,2018/9/22,2,脊柱和脊髓,MRI组织分辨率高 准确显示各解剖结构 显示多种病理改变 MRI多平面多参数成像 MRI是诊断脊髓病变的最佳选择,腰椎矢状位 T1WI,T2WI,2018/9/22,4,2018/9/22,5,正常影像表现,脊椎和椎间盘 椎管 椎管内结构,2018/9/22,7,Normal anatomy of lumbar spine,2018/9/22,8,Spinal canal 脊椎腔,Neuroforamen 神经孔,bone,disc,Dural sac,2018/9/22,9,
2、脊髓病变,椎管内肿瘤 脊髓外伤 脊柱脊髓先天畸形和发育障碍,2018/9/22,10,spinal cord neoplasms,Intramedullary spinal cord neoplasms are rare, accounting for about 4%10% of all central nervous system tumors. Despite their rarity, these lesions are important to the radiologist because MRI is the preoperative study of choice to nar
3、row the differential diagnosis and guide surgical resection.,2018/9/22,11,椎管内肿瘤分类,髓内肿瘤 室管膜瘤 星形胶质细胞瘤 髓外硬膜内肿瘤 神经鞘瘤、神经纤维瘤 脊膜瘤 硬膜外肿瘤 转移瘤、淋巴瘤、脂肪瘤,2018/9/22,12,Snake in House,Normal Anatomy,2018/9/22,13,Three Locations,Intramedullary Intraduralextramedullary Extradural,2018/9/22,14,Intramedullary,2018/9/2
4、2,15,Intradural Extramedullary,2018/9/22,16,Extradural,2018/9/22,17,2018/9/22,18,LEARNING OBJECTIVES,List the essential imaging features of intramedullary spinal cord neoplasms. Identify the characteristic imaging appearances of the different types of intramedullary spinal cord neoplasms that allow
5、a specific diagnosis to be favored.,2018/9/22,19,Three Important Tenets,Cord expansion At least some enhancement Cysts are a common associated finding in the setting of an intramedullary spinal tumor,2018/9/22,20,室管膜瘤Ependymoma,占髓内肿瘤60% 起源于脊髓中央管室管膜细胞或室管膜残留物 好发部位：腰骶段、脊髓圆锥、终丝 良性，呈膨胀性生长,2018/9/22,21,CT
6、,脊髓密度均匀性降低，不规则膨大 边缘模糊，常见囊变 轻度强化或不强化,2018/9/22,22,Intramedullary astrocytoma in an 18-year-old woman with progressive paresis, paresthesia of the lower extremities, and difficulty voiding. CT myelogram shows a near-compete block of intrathecal contrast material (arrowheads) secondary to an intramedul
7、lary mass.,2018/9/22,23,MRI表现,脊髓明显局限性增粗 T1WI为均匀低信号 T2WI为均匀高信号 可发生出血、囊变或合并脊髓空洞 增强后均匀强化，囊变区无强化,2018/9/22,24,Ependymoma,2018/9/22,25,Ependymoma,2018/9/22,26,Ependymoma,2018/9/22,27,Ependymoma,2018/9/22,28,Ependymoma,2018/9/22,29,星形细胞瘤Astrocytoma,占髓内肿瘤40%， 以胸颈段为多 病变一般局限，可浸润生长 脊髓增粗，与正常无明显界限,2018/9/22,30,
8、CT,平扫呈略低密度，少数高密度 边界不清 增强后强化不均一 囊变常见,2018/9/22,31,MRI,T1WI低信号 T2WI高信号，由于水肿T2范围T1 出血、坏死、囊变，信号不均 实质部分明显强化,2018/9/22,32,A: irregular expansion of the cervical spinal cord extending from C3 to C7 (arrows),slightly hypointense , expansion of the spinal canal . B: abnormal area of high signal intensity thr
9、oughout the expanded region.,2018/9/22,33,C: irregular, intense, homogeneous enhancement of the inferior portion of the expanded cord (arrows). D: Axial gradient-echo MRI ,expansion of the cord with the mass eccentrically located along its right margin (arrows).,2018/9/22,34,髓内转移瘤metastasis,乳癌髓内转移,2
10、018/9/22,35,Intramedullary spinal lymphoma. A： an ill-defined region of slightly high signal intensity (arrows) in the midthoracic spinal cord. B： abnormal high signal intensity (arrow) in the same region. Extensive cord edema (arrowheads) is also seen.,2018/9/22,36,神经鞘瘤neurinoma,最常见椎管内肿瘤 髓外硬膜内肿瘤 神经
11、鞘瘤起源于神经鞘膜的雪旺细胞,2018/9/22,37,CT,圆形实质性肿块，密度较脊髓略高，脊髓受压移位 中等强化 椎间孔扩大，椎弓根骨质吸收 哑铃状,2018/9/22,38,MRI表现,脊髓受压、移位、患侧蛛网膜下腔扩大 边缘光滑、境界锐利的圆形、卵圆形或哑铃状肿块影 多位于脊髓背侧 T1WI低信号，T2WI为高信号 可发生囊变、信号不均匀,2018/9/22,39,2018/9/22,40,2018/9/22,41,T1WI,2018/9/22,42,PDWI and T2WI,2018/9/22,43,2018/9/22,44,脊膜瘤spinal meningioma,髓外硬膜内肿瘤
12、，多位于胸段 起源于蛛网膜细胞 呈宽基底与硬脊膜粘连较紧,2018/9/22,45,CT,胸段蛛网膜下腔后方 实质性肿块，局限，椭圆形或圆形，有完整包膜 中等率强化,2018/9/22,46,MRI表现,病变处脊髓受压移位 类圆形肿块，境界清楚 T1WI呈低信号或等信号，T2WI呈高信号或等信号 合并囊变或钙化，信号可不均匀 显著强化，可出现脊膜尾征,2018/9/22,47,脊膜瘤spinal meningioma,2018/9/22,48,脊膜瘤,2018/9/22,49,脊膜瘤矢状位 MRI平扫、增强,2018/9/22,50,脊膜瘤,2018/9/22,51,脊髓外伤trauma,非常
13、严重损伤 占0.2-0.5% 车祸、工伤、运动、火器伤,2018/9/22,52,脊髓外伤,脊柱损伤 椎体骨折：正常结构丧失，椎体信号不均匀 脊椎脱位：椎体前缘、椎管前缘及后缘的平滑连线中断,2018/9/22,53,脊髓损伤 闭合损伤 病理上分为：脊髓震荡、脊髓挫裂伤、脊髓压迫或横断、椎管内血肿 脊髓挫裂伤示脊髓肿胀、膨大，信号混杂 脊髓压迫示脊髓、硬膜囊受压变形，脊髓内出现水肿、坏死,2018/9/22,54,2018/9/22,55,2018/9/22,56,2018/9/22,57,颈椎外伤骨折、椎间盘突出,2018/9/22,58,2018/9/22,59,2018/9/22,60,
14、2018/9/22,61,L3,M/43 Acute burst fracture of L3, causing severe stenosis of spinal canal,X-ray,CT,3-D,2018/9/22,62,影像能改变治疗方法并改善 预后及疗效吗？,2018/9/22,63,2018/9/22,64,2018/9/22,65,2018/9/22,66,2018/9/22,67,2018/9/22,68,2018/9/22,69,2018/9/22,70,C2、3椎体骨折伴脊髓横断伤,2018/9/22,71,C5、6术后，颈髓软化,2018/9/22,72,脊柱脊髓先天畸
15、形和发育障碍,脊膜膨出和脊髓脊膜膨出 脊髓空洞征,2018/9/22,73,脊膜膨出meningocele和脊髓脊膜膨出meningomyelocele,脊膜通过脊椎缺损部位向外呈囊袋状膨出 脊髓脊膜膨出是脊髓、脊神经、马尾与囊壁粘连并同时突出于椎管外 腰骶部最常见，颈椎次之,2018/9/22,74,腰骶部脊柱裂、脊膜膨出,2018/9/22,75,脊髓空洞症syringomyelia,病理特征 脊髓内出现空洞 洞壁由增生的胶质组织构成 交通性脊髓空洞症 脊髓积水、空洞伴有Chiari畸形 无肿瘤、外伤或蛛网膜炎 伴有肿瘤的脊髓空洞症 外伤后脊髓空洞症 特发性脊髓空洞症,2018/9/22,76,交通性脊髓空洞症MRI表现,空洞位于脊髓中央，呈管状囊腔 空洞内见水样信号 脊髓增粗，脊髓实质变薄,2018/9/22,77,脊髓空洞症,2018/9/22,78,Chiari 畸形,2018/9/22,79,2018/9/22,80,中年女性患者，术前MRI示头颈交界部的狭窄，对神经组织有卡压，颈段脊髓可见空洞。,2018/9/22,81,术后10年复查MRI示、两处手术部位，为枕下减压手术部位，为空洞分流手术部位。MRI片示卡压解除，空洞消失。仔细观察还可发现颈椎的曲度亦较术前改善。,2018/9/22,82,Thank you！,
