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1、脊柱病变的影像学诊断,山东省医学影像学研究所 李传亭,CT脊柱检查,CT脊柱检查,MRI检查脊柱的优势,总体优势： 多参数成像 多方位成像，尤其矢状断层 独特优势： 目前唯一能直接显示脊髓内部的影像检查方法,椎间盘病变,椎间盘及椎体的退变 椎间盘膨出和脱出 从脊柱长轴全面观察以免漏掉其他病变 观察突出椎间盘对脊髓或神经根的压迫程度,DEGENERATION,椎间盘变性： SET2 GRE T2* T1WI 椎体终板信号改变：,DEGENERATION,Normal,Post-radiotherapy,DISC-HERNIATION,DISC-HERNIATION,DISC-HERNIATION
2、,DISC-HERNIATION,DISC-HERNIATION,DISC-HERNIATION,椎管狭窄,分型： 中心型 外围型 先天型 后天型,颈椎病,DISC-HERNIATION,BASAL DEPRESSION,SPINAL CANAL STENOSIS,OPLL,脊柱创伤,观察脊髓的受伤程度： 水肿、肿胀、出血、断裂、软化 观察椎体的状况： 有形态改变的骨折 无明显形态改变的小梁骨折 观察椎管的其他改变： 增生、狭窄,脱位: 位置错位 3.5cm 成角 11度,TRAUMA,TRAUMA 脊髓震荡 脊髓受压 脊髓挫伤,脊髓损伤,三型: 1 挫伤伴出血 2 水肿 3 混合,TRAUM
3、A,TRAUMA,TRAUMA,椎管肿瘤,髓内肿瘤 髓外硬膜下肿瘤 硬膜外肿瘤,髓内肿瘤 Intramedullary Spinal Neoplasms,Ependymoma(室管膜瘤),The most common intramedullary spinal neoplasm in adults, 60% , 38.8 , male Cervical cord alone the upper thoracic region. Myxopapillary ependymoma Duration of symptoms was 36.5 months Back or neck pain (67
4、%), sensory deficits (52%), motor weakness (46%),Imaging Characteristics,CT X-ray: scoliosis or canal widening with associated vertebral body scalloping, pedicle erosion, or laminar thinning MRI: T1WI iso- or hypointense; T2WI hyperintense the “cap sign,“ a rim of extreme hypointensity (seen at the
5、poles of the tumor on T2WI. cord edema. 3.6 vertebral segments; Cysts are a common , Syringohydromyelia Well contrast-enhanced,室管膜瘤,髓内肿瘤,室管膜瘤,室管膜瘤,Astrocytoma (星形细胞瘤),One-third of all spinal cord gliomas； Male； 29 years；thoracic cord (67% ), cervical cord (49%) ；Involvement of the entire spinal cord
6、；rare filum terminale ；rarely exophytic. Pain and sensory deficits ；Motor dysfunction. Young children, with a median duration of 5 months.,Pathologic Characteristics,Ill-defined diffuse fusiform enlargement. Tumor cysts (eccentric, smaller, and irregular) and syrinxes are common Hypercellularity and
7、 the absence of a surrounding capsule Enlarged, irregularly shaped, hyperchromatic nuclei,WHO classification,Grade I： pilocytic astrocytomas 75% Grade II ：fibrillary type Grade III ：anaplastic astrocytomas 25% Grade IV ：glioblastoma multiforme distinctly uncommon,Grade II,Grade IV,Imaging Characteri
8、stics,CT 、X-ray：mild scoliosis, widened interpedicular distance, and bone erosion MRI：poorly defined margins ；T1WI iso- to hypointense ； T2WI hyperintense；seven vertebral segments； Cysts；eccentric； some enhancement,星形细胞瘤,髓内肿瘤,星形细胞瘤,星形细胞瘤,星形细胞瘤,Hemangioblastoma 血管母细胞瘤,Thoracic cord (50%), solitary ,y
9、ounger than 40 ys . Highly vascular, discrete, nodular, red-to-orange masses abutting the leptomeninges with prominent dilated and tortuous vessels on the posterior cord surface . Syrinx is common,Imaging Characteristics,CT : hypoattenuated cystlike mass MRI: diffuse cord expansion and variable sign
10、al intensity on T1WI, isointense (50% o) or hyperintense (25%); T2WI high signal intensity with intermixed focal flow voids, cyst formation or syringohydromyelia cystic mass with an enhancing mural nodule,血管母细胞瘤,血管母细胞瘤,Metastasis (转移瘤）,Solitary, two to three vertebral segments, cervical cord mild co
11、rd expansion over several segments. T1WI central area of low signal intensity (mimicking a syrinx); T2WI high signal intensity ; Cysts are rare . Enhance intensely and homogeneously,转移瘤,转移瘤,髓外硬膜下肿瘤,脊膜瘤 增强扫描十分重要 可明确肿瘤位于硬膜内 可显示脊膜瘤的特征： 宽基底附着于硬脊膜,MENINGIOMA,MENINGIOMA-1,MENINGIOMA-2,神经纤维（鞘）瘤,沿神经鞘同时存在于椎管
12、内外 T2WI高信号 明显增强 内部多有坏死 多发,神经纤维瘤,神经纤维瘤,神经鞘瘤,TERATOMA,其他肿瘤,TERATOMA,METASTASIS,SUBDURAL CYST,SACRUM CANAL CYST,硬膜外肿瘤,单纯硬膜外软组织肿瘤 椎体肿瘤 椎体并软组织肿瘤,METASTASIS,METASTASIS-1,METASTASIS-2,脊索瘤,脊索瘤,METASTASIS,METASTASIS,METASTASIS,ACIDOPHIL GRANULOMA,MULTIPLE MYELOMA,脊柱先天畸形,脊髓脊椎的发育和解剖 神经管闭合不全 脊柱裂: 隐性;伴脊膜膨出;伴脊髓脊膜
13、膨出,脊柱裂 脊髓栓系,脊膜膨出,脊髓纵裂,TETHERED CORD,TETHERED CORD,脊髓空洞症,鉴别空洞的类型:先天性和继发性 空洞和积水 确认累及范围,SYRINGOMYELIA,SYRINGOMYELIA,SYRINGOMYELIA,SYRINGOMYELIA (DIFFERENT TYPE),复习题,1、急、慢性化脓性骨髓炎的发病过程和影像学表现。 2、脊柱结核的影像学表现。 3 、化脓性关节炎与滑膜型关节结核的鉴别诊断。 4 、类风湿性关节炎的影像学表现。 5、强直性脊柱炎的影像学表现 6 、退行性骨关节病的影像学表现特点。 7、脊髓内星形细胞瘤与室管膜瘤的鉴别诊断,谢谢,
