脊柱肿瘤和肿瘤样病变课件2.ppt

1、T12FigA:Radiograph reveals a subtle lucent area(arrow)in a right articular mass.FigB:CT scan shows the nidus(large arrowheads)with a small central area of calcification(small arrowhead)and minimal surrounding sclerosis.FigC:Radiograph of the resected specimen shows that the nidus was entirely remove

2、d(arrows).FigD:Posterior bone scan shows intense uptake of the radionuclide by the nidus(arrow)17,yr,M Osteoid osteoma of lamina at T-11 Fig.A L radiographFig.B CTFig.D Sag.T2WIFig.C Axi.T1WILateral x-ray films(a)showed a soft-tissue swelling in the retropharyngeal space.Lateral(b)and coronal(c)MR i

3、mages demonstrating tumor in the C-2 body and a soft-tissue mass from C16.Axial CT scan(d)demonstrating a typical osteoid nidus with peritumoral sclerotic rim on the right side of the C-2 body.Technetium bone scan(e)also displays pronounced uptake in this region.We performed tumor excision via an an

4、terolateral retropharyngeal approach(f)occipitocervical fixation by using two axis plates and titanium wires(g).Lateral x-ray films obtained immediately after(h)and 2 years postsurgery(i)showing solid fusion.10,yr,M osteoblastoma of C2 ChordomaFig.ALateral radiograph shows destruction of the distal

5、sacrum and coccyx with calcification(arrow).Fig.BCT scan also demonstrates the bone destruction and a soft-tissue mass(arrowheads)containing calcifications(arrow).Chordoma of lower sacrum 48-year-old manFig.AFig.B脊索瘤Fig.C T1WI Sagittal and axial T2WI Fig.DMR images reveal the expansile sacrococcygea

6、l lesion (arrowheads),which has high signal intensity on D.Fig.CFig.D脊索瘤脊索瘤Fig.E As seen in this sagittal section of the gross specimen,the MR imaging appearance correlates with the expansile lesion(arrowheads)and calcification(arrow).The upper sacrum(*)is spared脊索瘤Upper Left and Right:Axial CT scan

7、s demonstrating a large soft-tissue mass extending anteriorly to involve the rectum and posteriorly to invade the buttocks;calcification is seen within the mass.Lower Left and Right:Sagittal fast spin echo T2-weighted and axial T2-weighted MR images demonstrating the lesion infiltrating the presacra

8、l region,extending to surround the rectum and the perivesical fat but not invading the bladder.24-yr Mchordoma involving S3-5脊索瘤chordomaFig.AFig.B脊索瘤脊索瘤残存椎间盘形成的“分节”现象Fig.ALateral radiograph shows a dense vertebral body(arrows)at L-3.Fig.BSagittal reconstructed CT scan obtained after initial open bio

9、psy reveals not only the L-3 sclerosis but also similar findings in the superior aspect of L-4(arrowheads).Chordoma of L 13-year-old man1-yr history of intermittent low back pain.Fig.AFig.B脊索瘤Sagittal T1WIFig.Cand T2WIFig.D MR images better delineate the marrow involvement at L-3 and L-4 with extens

10、ion through the disk(arrows).The mass has marked high signal intensity on d.Fig.CFig.DFig.Egross specimen depicts the extent of the neoplasm,with diffuse involvement of L-3(arrowheads),the adjacent disk(*),and the superior aspect of L-4(arrows).Fig.E脊索瘤 起源于红骨髓的恶性肿瘤 高分化型(小细胞型)：浆细胞型骨髓瘤 低分化型(大细胞型)：网状细胞

11、型骨髓瘤 椎体为其好发部位，绝大多数为多发；单发少见，且约1/3可转变为多发。晚期可广泛转移。40岁以上常见，男:女2:1 表现为骨骼疼痛，软组织肿块，病理性骨折 实验室检查血沉加快、尿B-J蛋白、贫血等。Fig.Multiple plasmacytomas with cord compression.a Sagittal T1WI(left)andbSTIR(right)MRI of thoracic spine show scattered focal lesions involving vertebral bodies and posterior elements of thoracic

12、 spine.Bothc transverse and sagittal(a,left)MRI show cord compression by a focal expansile mass(arrow)at the T10 spinous process.abcMyeloma of T5-T7 T1WI STIR T2WI STIRsclerotic metastasesFigure.Sagittal T1-weighted MR image of the lumbosacral spine shows multiple hypointense foci within the sacrum

13、and lumbar vertebrae.These lesions remained hypointense with all of the MR imaging sequences and did not exhibit enhancement.Plain radiography revealed sclerotic metastases.77-yr FMetastatic breast cancerFig.A:Sagittal T2-weighted MR image demonstrating involvement of the posterior elements of L-3(a

14、rrow).Fig.B:Axial T1-weighted MR image revealing the L-3 spinous process and lamina infiltrated by tumor,with anterior structures intact(arrow).Fig.c:Bone scan demonstrating numerous additional sites of metastatic disease(ribs,skull,and scapula)in addition to L-3(arrow).The patient underwent simple posterior decompression.54-yr Mmetastatic renal cell carcinomaABC CTvertebra plana can be seen(arrow)in the thoracic spine,which is consistent with Langerhans cell histiocytosis.8,yr,M of TThank You