脊柱肿瘤的影像学诊疗分析培训课件.ppt

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1、本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。胸段本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅

2、供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学

3、依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当

4、之处,请联系网站或本人删除。T重建重建本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。L本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。C 本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。临床病理临床病理 本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科

5、学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Fig.A thickened trabeculae(corduroy sign)of a vertebral body hemangioma can be seen on this lateral view,which is coned d

6、own to the L2 vertebral bodyFig.B T1WI and Fig.C T2WI show the typical increased signal intensity of a vertebral bodyABC本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。临床病理临床病理本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参

7、考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。38,yr,M of CHereditary multiple exostosis with several spinal osteochondromasFigA:Lateral radiograph of the cervical spine shows a C-4 spinous process osteochondroma with pathognomonic marrow and cortical continuity solid arrow).Osteochondroma at C-1 is seen as an

8、 ossified region(open rrow)Axial FigB and sagittal FigC reconstructed CT scans reveal cortex and marrow of the osteochondroma(arrows),impingement on the spinal canal,extrinsic erosion of C-2(arrowheads in b),and continuity with the C-1 spinous process(*in c).本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网

9、站或本人删除。Sagittal T1-weighted FigDand T2*gradient-echo FigEMR images reveal the signal intensity characteristic of yellow marrow within the osteochondroma and the impression of the tumor on the spinal canal(arrows),although the marrow and cortical continuity is not well seen.本文档所提供的信息仅供参考之用,不能作为科学依据,请

10、勿模仿;如有不当之处,请联系网站或本人删除。FigF:Photograph of the gross specimen shows the marrow and cortex of the osteochondroma and a small cartilage cap at its periphery(arrowheads).本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。35yr,F Osteochondroma of sacrummalignant transformationFigAVague sclerosis(solid arrows

11、)over the left sacrum and widening of the sacroiliac joint(open arrow).FigA本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。FigCAxial CT scan shows the thick cartilage cap(arrows)and sacroiliac joint invasion,which represents malignant transformation.FigB Coronal reconstructed CT scan shows the corte

12、x and marrow canal of the osteochondroma(arrows)and continuity with the sacrum(arrowheads).Fig BFigC本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。multiple hereditary exostoses.Note that the large sacral lesion has normal cortex as well as marrow arising from the underlying bone.This appearance def

13、ines an exostosis.We look for a thick cartilage cap to suggest degeneration of an exostosis to a chondrosarcoma.In this case,there is no space for a thick cap because the edge of the exostosis extends to the subcutaneous tissue.If there is any question,MR imaging can demonstrate the cartilage thickn

14、ess.In this case,we recognized multiple exostoses because of the presence of sessile lesions at the anterior superior iliac spines.10,yr,M Multiple hereditary exostoses本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。临床病理临床病理本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为

15、科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Fig A and Fig B a large expansile lesion of the T-4 vertebral body(arrows),with extension into the posterior elements of T-3 and T-4 and the posterior soft tissues(arrowheads).The lesion enhances markedly with the co

16、ntrast agent.FigC the lesion has only intermediate signal intensity,28,yr,FGCT of T-3 and T-4Sag.T1WIAxi.T1WI +cSag.T2WI本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Intraoperative photograph obtained after incision of the skin shows a bulging,solid paraspinal mass(*)FigD本文档所提供的信息仅供参考之用,不能作为科学依据,请

17、勿模仿;如有不当之处,请联系网站或本人删除。sacral GCT.A-PLateraLFig AFig b本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Axial CTSag.T2WI soft-tissue extension.Cor.T2WIFig CFig DFig EFig F本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。GCT of S4-521 yr,FA-PLateraLAB本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。FigC:C

18、Tshowing large mass of SFigD:demonstrating an inhomogeneous mass that contains several areas of low signal intensity(arrows;contrast this signal to the very high signal intensity FigE:revealing that the lesion is of low signal intensity;the large presacral mass displacing the rectum is confirmed.Fig

19、F:revealing only mild enhancement,again with several areas of relatively low signal intensity.These low-signal regions represent a common feature in GCTsAxial CTSag.T1WIAxi.FSE T2WISag.FS T1WI+C本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Upper Left:Anteroposterior radiograph emonstrating the exp

20、anded lytic lesion ccupying the sacrum.Upper Right and Center Left:Axial CT scans obtained several months later,demonstrating the rather featureless lytic lesion occupying the entire sacrum,with attempted thin cortical rim unable to contain the expansive lesion.Center Right:Sagittal T1-weighted MR i

21、mage(TR/TE 450/10 msec)demonstrating intensity presacral soft-tissue extensionLower Left and Right:Sagittal T2WI and axial FSE T2WI revealing the inhomogeneous mixed high and low signal intensity mass,typical of GCT.26,yr,F GCT of the sacrum.本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。GCT of C-7

22、 posterior elements16 y male本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。临床病理临床病理本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。FigA:Rad

23、iograph 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 removed(arrows).F

24、igD:Posterior bone scan shows intense uptake of the radionuclide by the nidus(arrow)17,yr,M Osteoid osteoma of lamina at T-11 本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。FigE:Photograph of the gross specimen reveals the nidus(*)extending to the facet cartilage(arrows)本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模

25、仿;如有不当之处,请联系网站或本人删除。Axial CT scan(left)revealing that a tumor arising from the left C-5 pedicle is compressing the left C-5 root.Bone scan(center)displays high uptake of contrast material.Axial CT scan(right)demonstrating that left hemilaminectomy was sufficient to remove the tumor.16,yr,M Osteoid o

26、steoma of lamina at C-5 本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。临床病理临床病理本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Fig.Ashows a markedly expansile lesion involving the spinous

27、 process and laminae(arrows),with vague sclerosis suggestive of mineralization.Fig.BCT scan reveals the marked expansion of the lesion,which has a defined sclerotic rim(arrows),and its encroachment on the spinal canal.Matrix mineralization(arrowheads),16,yr,M.osteoblastoma of C-3 Fig.A L radiographF

28、ig.B CT本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Axi.T1WI FigCand Sag.T2WI FigD show the mass(arrows)and its degree of encroachment on the spinal canal(arrowheads in c).Because of its extensive mineralization,the mass has relatively low signal intensity on the T2-weighted image.Axi.T1WISag.T2W

29、IFigCFigD:本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。FigE本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。FigA:CT scan shows a destructive,expansile lesion of the left lateral side of C-1(arrows)with small foci of mineralized matrix peripherally(arrowheads)and invasion of the surrounding soft ti

30、ssues and foramen transversarium.FigB:Coronal T2-weighted MR image shows high signal intensity within the mass(arrows).FigC:Digital subtraction angiogram reveals tumor stain(straight arrows)and obstruction of the left vertebral artery(curved arrow).9,yr,M.Aggressive osteoblastoma of C1本文档所提供的信息仅供参考之

31、用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Left:Anteroposterior radiograph revealing a subtly expanded lesion that is near the midline at S4-5(arrows).Right:Axial CT scan demonstrating bone matrix within the lesion,not aggressive in appearance.16,yr,M osteoblastoma of S4-5 本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之

32、处,请联系网站或本人删除。Left:bone scan revealing an eccentrically located area of increased uptake in the sacrum.Right:The CT scan demonstrates a minimally expanded lesion containing dense bone matrix in the right side of the lower sacrum.16,yr,M.osteoblastoma of S4-5 本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站

33、或本人删除。Lateral x-ray films(a)showed a soft-tissue swelling in the retropharyngeal space.Lateral(b)and coronal(c)MR images 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

34、-2 body.Technetium bone scan(e)also displays pronounced uptake in this region.We performed tumor excision via an anterolateral 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(

35、i)showing solid fusion.10,yr,M osteoblastoma of C2 本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。临床病理临床病理本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Fig.A and after Fig.B administrat

36、ion of gadopentetate dimeglumine reveal a markedly expansile lesion involving the laminae of T-3(large arrowheads)and encroaching on the spinal canal(small arrowheads).Enhancement occurs largely in the periphery and septations of the lesion.Fig.C Sagittal T2-weighted MR image shows that the entire l

37、esion contains fluid-fluid levels(arrows)resulting from hemorrhagic spaces and shows the extent of spinal canal narrowing.8yr,M ABC of T3ABC动脉瘤样骨囊肿动脉瘤样骨囊肿液-液平面(血窦)本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Photograph of the sagittally sectioned gross specimen demonstrates the multiple blood-fil

38、led spaces(arrows)in the lesion.Fig.D血窦血窦动脉瘤样骨囊肿动脉瘤样骨囊肿本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Fig.A The anteroposterior radiograph can be easily misread as normal because of the overlying bowel gas obscuring the sacrumFig.B A lateral radiograph demonstrates only obscuration of the S-3 poste

39、rior elements(arrows)Fig.CThe lesion is more readily seen on the CT scan obtained with the patient in a prone position.This scan demonstrates a lytic lesion occupying the left S-3 ala,with a thin cortical rim surrounding the majority of the lesion.Note that the more lucent regions in the center of t

40、he lesion actually represent fluid levels.Fig.DFluid levels(short arrow)are more readily observed on a sagittal T1-weighted MR image;remember that the patient is supine in the imager and that the fluid levels on the sagittal exam would then be expected to appear vertical,as in this case.The high sig

41、nal intensity portion of the fluid is blood.Most,but not all,ABCs contain fluid levels.Conversely,most lesions with substantial fluid levels are ABCs,but such levels may occur in other lesions as well.Note also in this case that there is a substantial component of the lesion located anteriorly to th

42、e fluid levels that is solid(long arrows).14,yr,M ABC of SADCB液-液平面(血窦)动脉瘤样骨囊肿动脉瘤样骨囊肿本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。neurysmal Bone CystFig.A Computed tomographic scan showing alytic lesion in the posterior elements of the vertebrae at the T10-T12 level,with expansion to the vertebra

43、l body from the left.This process with a thin periosteal border enters the spinal canal,pressing the cord forward and to the rightFig.B Magnetic resonance imaging after injection with gadolinium shows a nonhomogeneous multilobular lesion at T10-T12 level,extradurally pressing the spinal cord forward

44、 and to the right,destroying the pedicle and the lamina of the vertebra.Fig.AFig.B动脉瘤样骨囊肿动脉瘤样骨囊肿本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。临床病理临床病理本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现 本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。vertebra plana can be seen(arrow)in the tho

45、racic spine,which is consistent with Langerhans cell histiocytosis.8,yr,M of T本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。临床病理临床病理本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Fig.A Lateral radiograph shows a sclerotic focus in the anteri

46、or portion of L-3(arrowhead).Fig.B CT scan reveals a densely sclerotic lesion with an irregular spiculated border just beneath the anterior cortex to the left of midline(arrowheads)66-yr-old M Enostosis of L-3Fig.AFig.B本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Fig.A Lateral radiograph reveals

47、a sclerotic focus(large arrows)with areas of spiculated thornlike margins(small arrows).Fig.B Photomicrograph(original magnification,X150;hematoxylin-eosin stain)shows cortical bone(arrows)with irregular margins(arrowheads).35-yr-old FGiant enostosis of L-2Fig.BFig.B本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不

48、当之处,请联系网站或本人删除。脊柱恶性肿瘤脊柱恶性肿瘤本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。临床病理临床病理本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。影像表现影像表现本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。F

49、ig.ALateral radiograph shows destruction of the distal 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脊索瘤本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿

50、;如有不当之处,请联系网站或本人删除。Fig.C T1WI Sagittal and axial T2WI Fig.DMR images reveal the expansile sacrococcygeal lesion (arrowheads),which has high signal intensity on D.Fig.CFig.D脊索瘤脊索瘤本文档所提供的信息仅供参考之用,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。Fig.E As seen in this sagittal section of the gross specimen,the MR imagin

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