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摘要:目的:分析脊柱转移瘤的MRI表现及其类型,与ECT比较病灶检出的敏感性。材料和方法:回顾分析182例脊柱转移瘤,其中124例已知原发灶并经组织学证实,其他58例无明确原发灶但通过随访复查证实。分别观察椎骨受累部位、椎间盘变化、椎旁肿块、硬膜囊及脊髓内转移等表现。结果:182例椎骨受侵累计945个。单发转移30.8％(56/182),多发转移69.2％(126/182),全脊柱骨髓置换型转移12.1％(22/182),硬膜囊内种植转移和髓内转移分别为5.5％(10/182)和2.8％(5/182)。附件受累达62.5％(113/182),椎间盘受累为3.3％(6/182)。37.3％(68/182)伴有病理性骨折。51.6％(94/182)伴有椎旁软组织肿块。椎骨破坏6796(122/182)表现为溶骨性,6％(11/182)表现为成骨性,27％(43/182)表现为混合性。44例ECT骨扫描检出率为72.9％,不能显示硬膜囊种植和髓内转移。结论:脊柱转移瘤以多发性溶骨破坏为其特征。根据MRI表现可分成椎骨型、全脊柱骨髓置换型、硬膜囊种植型和髓内型。分型有助于全面估价脊柱转移,并与其它病变相鉴别。MRI比ECT骨扫描更早、更全面估价脊柱转移瘤。
Abstract : Objective: To analyze the MRI features and types of spinal metastatic tumors and to compare the sensitivity of lesion detection with ECT. Materials and Methods: A retrospective analysis of 182 cases of spinal metastases, of which 124 cases were known for primary lesions and confirmed by histology, the other 58 cases without clear primary lesions but confirmed by follow-up review. Observed the site of vertebral involvement, disc changes, paravertebral masses, dural sac and intraspinal metastases. Results: A total of 945 cases of vertebrae were involved in 182 cases. The rate of single metastasis was 30.8% (56/182), multiple metastasis was 69.2% (126/182), total spinal bone marrow metastasis was 12.1% (22/182), and dural cyst implantation metastasis and intramedullary metastasis were 5.5% ( 10/182) and 2.8% (5/182). The attachment was affected by 62.5% (113/182) and the disc involvement was 3.3% (6/182). 37.3% (68/182) had a pathological fracture. 51.6% (94/182) were associated with paravertebral soft tissue masses. The vertebral destruction 6796 (122/182) showed osteolysis, 6% (11/182) showed osteogenic, and 27% (43/182) showed mixed. The detection rate of ECT scan in 44 cases was 72.9%. It could not show dural sac and intramedullary metastasis. Conclusion: Spinal metastases are characterized by multiple osteolytic destruction. According to MRI performance can be divided into vertebral type, bone marrow replacement of the entire spinal, dural sac type and intramedullary type. Typing helps to fully evaluate spinal metastases and differentiates them from other lesions. MRI estimates spinal metastases earlier and more comprehensively than ECT bone scans.