贵州医科大学学报

2005, (03) 225-229

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脊柱转移瘤和脊柱结核MRI鉴别诊断
Differential Diagnosis of Spinal Metastatic Tumor and Spinal Tuberculosis with Magnetic Resonance Imaging

杨生佑,赵震奇
YANG Sheng-you, ZHAO Zhen-qi (Department of Radiology, The Affiliated Hospital of Guiyang Medical College, Guiyang 550004, China)

摘要(Abstract):

目的:探讨脊柱转移瘤和结核MRI不同表现。方法:分析经临床或病理证实的脊柱转移瘤和结核各30例的MRI资料,并进行总结。结果:(1)转移瘤多为跳跃性骨质破坏,发生于椎体的中后部,易累及椎弓根,椎体压缩呈盘状后突征,椎间盘呈嵌入征。椎旁软组织肿块局限,呈均匀强化;(2)结核累及相邻两个椎体,好发于椎体的前部,亦可累及椎弓根,椎体压缩后缘表现为成角畸形,破坏椎间盘。椎旁软组织肿块常呈梭形或长条状,多为环形强化。结论:(1)骨质破坏的分布、椎体累及的部位、椎间盘以及椎旁软组织肿块的形态是鉴别转移瘤和结核的重要方面;(2)盘状后突征、成角畸形、椎间盘嵌入征、环状强化则是两者鉴别诊断的主要影像学征象。
Objective: To investigate the difference between the magnetic resonance imaging (MRI) of spinal metastatic tumor and spinal tuberculosis. Methods: MRI features of 30 cases of spinal metastatic tumor and 30 cases of spinal tuberculosis confirmed pathologically or clinically were analyzed. Results:1)The characteristics of MRI of spinal metastatic tumor were that the bone destruction was skipping, and mainly situated at posterio-median portion of vertebral body, usually involving pedicle of vertebral arch.Vertebral body was compressed like a plate. Intervertebral disc protruded like“insertion”.Tumor in papravertebral soft tissue was localized and homogenously enhanced. 2)MRI features of tuberculosis were that bone destruction distributed continuously, and mainly situated at anterior portion of vertebral body, also involving pedicle of vertebral arch.Vertebral body was compressed into angle shape. Intervertebral disc was destructed. Mass in papravertebral soft tissue was shuttle-shaped or strip-shaped with a rim of enhancement. Conclusions:The distribution of bone destruction, lesion location in vertebral body, shape features of intervertebral disc and papravertebral mass are the main evidences for differential diagnosis of spinal metastatic tumor and spinal tuberculosis. The shape of compressed vertebral body and enhancement feature of papravertebral mass are important image signs.

关键词(KeyWords): 脊柱疾病;肿瘤转移;结核,脊柱;磁共振成像
spinal diseases; neoplasm metastasis; tuberculosis, spinal; magnetic resonance imaging

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作者(Author): 杨生佑,赵震奇
YANG Sheng-you, ZHAO Zhen-qi (Department of Radiology, The Affiliated Hospital of Guiyang Medical College, Guiyang 550004, China)

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