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目的分析脊柱恶性外周神经鞘瘤(malignant peripheral nerve sheath tumor,MPNST)的CT和MRI表现,提高术前对该病诊断的准确性。资料与方法回顾性分析12例经病理证实的脊柱MPNST的CT(n=10)和/或MRI(n=11)表现。结果 MPNST表现为类圆形(n=2)或不规则分叶状(n=10)肿块。3例未见明显骨质破坏,9例有邻近椎骨侵犯,主要侵犯神经孔相邻的椎弓根、椎板及相邻局部椎体,骨质破坏以溶骨性骨质破坏(n=8)为主,少数(n=1)为溶骨性骨质破坏与不规则瘤骨同时存在。CT平扫肿块呈等密度(n=4),等、低混杂密度(n=4)或等、高混杂密度(n=2)。MR T2WI和T1WI上均呈以长T2、长T1为主的混杂信号,内部可见片状T2WI高信号(n=8)或点、条状低信号(n=2)或簇状血管影(n=1)。增强扫描肿块多表现为不均匀强化,内部可见不强化坏死区。10例可见神经孔增宽;9例可见肿块与脊神经相连。结论 CT或MRI像上出现神经孔扩大、周围明显骨质破坏、增强扫描不均匀强化、内部有无强化坏死区的脊柱占位性病变,特别是肿块与脊神经相连时应考虑脊柱MPNST可能。
Objective To analyze the CT and MRI findings of malignant peripheral nerve sheath tumor (MPNST) and to improve the accuracy of preoperative diagnosis of the disease. Materials and Methods Retrospective analysis of CT (n = 10) and / or MRI (n = 11) manifestations of 12 spine MPNST confirmed by pathology. Results MPNST showed either round (n = 2) or irregular lobulated (n = 10) masses. Three cases showed no obvious bone destruction, and 9 cases had adjacent vertebrae invasion. The main invasion was the adjacent pedicle, lamina and adjacent vertebrae of the nerve hole. The destruction of osteolytic osteolytic bone (n = 8) was The main, a few (n = 1) for osteolytic bone destruction and irregular tumor at the same time. CT scan mass showed equal density (n = 4), and so on, low hybrid density (n = 4) or equal, high hybrid density (n = 2). Both MR T2WI and T1WI presented mixed signals mainly with long T2 and long T1, and internal T2WI high signal (n = 8) or spot, low signal strip (n = 2) or clustered vessel n = 1). Enhance the performance of the scan showed more uneven heterogeneity, the internal can not see the area of necrosis. Ten cases showed widened neural pore; 9 cases showed mass and spinal nerve connected. Conclusions The enlargement of the nerve hole on the CT or MRI image, obvious surrounding bone destruction, enhancement of uneven enhancement of the scan, and the presence or absence of spinal space-occupying lesions in the area of enhanced necrosis may be considered when the mass is connected to the spinal nerves.