1、脊柱腫瘤的影像學診斷 上海中醫藥大學龍華醫院放射科 王 嵩.脊柱腫瘤的影像學診斷脊柱大體解剖脊柱檢查技術脊柱影像解剖脊柱良性腫瘤和腫瘤樣病變脊柱惡性腫瘤.脊 柱大體解剖.頸段：7個頸椎胸段：12個胸椎腰段：5個腰椎骶段：5個骶椎尾段：4個尾骨椎間盤、椎間關節、椎旁韌帶等 胸段.椎骨:椎體、椎弓和7個骨性突起組成椎弓:椎板、椎弓根，相鄰椎弓根間構成椎間孔椎管:各椎骨的椎孔共同連成頸椎環椎:前后弓及兩側塊樞椎:齒狀突、椎體及棘突第3至第7椎體：逐漸增大，椎孔三角形，椎間關節面近呈程度位，鉤椎關節Luscka 關節胸椎：逐漸增大，椎孔心形，關節突關節面呈冠狀位腰椎：椎體逐漸增大，椎孔呈三角形，關節突

2、關節面呈矢狀位骶骨：骶骨倒立扁三角形，5個骶椎交融而成尾骨: 4個尾椎交融而成 骨性椎管的特點. 骨間銜接椎體間銜接前縱韌帶、后縱韌帶、椎間盤椎板及附件間銜接黃韌帶、棘間韌帶、棘上韌帶、項韌帶橫突間韌帶、關節突關節環樞關節、環椎橫韌帶.posterior Anterior . R lateralL lateral.C1-2.C3-7.T.L.SCo.檢 查 技 術 Examination Methods.檢查技術常規X線 :最主要和首選的檢查方法 CT:處理臨床和X線診斷疑問的第二步檢查方法 MRI :示X線甚至CT不能顯示和顯示不佳的某些組織構造 核素掃描 :一種全身骨骼檢查，但缺乏特異性

3、.影 像 解 剖 Radiologic Anatomy.常 規 X 線 C.T.LA-PLateral.L- oblique .CT解剖T重建.LCT解剖.MRI解剖C. 脊柱良性腫瘤和腫瘤樣病變 Benign Spinal Tumor and Tumorlike Lesion.脊柱良性腫瘤和腫瘤樣病變骨血管瘤骨軟骨瘤骨巨細胞瘤骨樣骨瘤骨母細胞瘤動脈瘤樣骨囊腫骨嗜酸性肉芽腫內生骨疣其它：軟骨黏液樣纖維瘤、纖維骨瘤、血管外皮細胞瘤和血管內皮細胞瘤等.骨血管瘤Hemangioma.最常見的脊柱原發良性腫瘤低血壓慢血流血管組成，摻雜于骨小梁和脂肪間，易出血病理上分毛細血管型和海綿狀血管型多胸椎椎體,

4、多單椎體病變 任何年齡均可發生，普通無病癥，多女性對放射線有相當的敏感性 骨血管瘤 臨床病理 .骨血管瘤 影像表現X線一為受累骨體積擴張，骨小梁廣泛的吸收、增生和增厚，椎體呈柵欄狀特征性表現一為受累骨質有肥皂泡沫樣的破壞和擴張.骨血管瘤 影像表現 CT椎體部分或全部松質骨密度減低病變區骨小梁減少，變粗致密冠狀面或矢狀面重建顯示柵欄狀表現加強掃描，病變常不強化或輕度強化 MRIT1WI和T2WI上均呈高信號加強掃描，中度至明顯強化.Plain film CTT骨血管瘤.T骨血管瘤.Fig. A thickened trabeculae (corduroy sign) of a vertebral

5、 body hemangioma can be seen on this lateral view, which is coned down to the L2 vertebral bodyFig. B T1WI and Fig. C T2WI show the typical increased signal intensity of a vertebral body ABC骨血管瘤.骨軟骨瘤Osteochondroma. 臨床病理由骨質組成的基底和瘤體、透明軟骨組成的帽蓋和纖維組成的包膜三種不同組織構成,又稱外生骨疣發生于脊椎少見，發生于脊柱單發1.31.4%，多發者9%約50%于頸椎，其

6、次胸椎及腰椎;常見于附件兒童期生長緩慢，青春期迅速近1病人的骨軟骨瘤發生惡變多兒童和青年男性，普通無病癥治療應徹底手術切除骨軟骨瘤.骨軟骨瘤 影像表現X線僅21%的起于棘突的較大病變被明確診斷小病變和突入椎管內的腫瘤很難診斷15%顯示正常 .骨軟骨瘤 影像表現CT附件骨性腫塊，皮質與椎板皮質相連可伴脊髓受壓 MRI病灶中心T1WI呈高信號，T2WI呈中等信號邊緣皮質均呈低信號軟骨帽常既薄又小，T1WI呈低至中等信號，T2WI呈高信號成人如軟骨帽明顯增厚大于1-2cm那么應疑心惡變.38, yr, M of CHereditary multiple exostosis with several

7、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 ossified region (open rrow)Axial FigB and sagittal FigC reconstructed CT scans reveal co

8、rtex 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). ABC骨軟骨瘤.Sagittal T1-weighted FigDand T2* gradient-echo FigEMR images reveal the signal intensity characteristic of yellow

9、 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. 骨軟骨瘤DE.FigF: Photograph of the gross specimen shows the marrow and cortex of the osteochondroma and a small cartilage cap at its periphery (ar

10、rowheads). .35yr，F Osteochondroma of sacrummalignant transformationFigAVague sclerosis (solid arrows) over the left sacrum and widening of the sacroiliac joint (open arrow).FigA.FigCAxial CT scan shows the thick cartilage cap (arrows) and sacroiliac joint invasion, which represents malignant transfo

11、rmation.FigB Coronal reconstructed CT scan shows the cortex and marrow canal of the osteochondroma (arrows) and continuity with the sacrum (arrowheads).Fig BFigC.multiple hereditary exostoses. Note that the large sacral lesion has normal cortex as well as marrow arising from the underlying bone. Thi

12、s appearance defines 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

13、 the cartilage thickness. 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.骨巨細胞瘤Giant Cell Tumor, GCT.骨巨細胞瘤 臨床病理由軟而脆且易出血的肉芽樣組織所構成，無纖維包膜，可出血和壞死組織學分三級：級為良性，級為過渡類型，級為惡性患者多女性，發病年齡多20-40

14、歲約1/3發生于脊柱，最常累及骶骨，其次為胸椎、頸椎和腰椎；多見于附件絕大多數為良性，約25%為惡性臨床病癥主要為部分疼痛、無力和覺得異常治療多全切治療，假設僅刮除術會出現40-60%復發.骨巨細胞瘤 影像表現X線典型呈膨脹性偏心性多房性骨質破壞，骨殼較薄，輪廓普通完好，內見纖細骨嵴構成分房狀幾點提示惡性a，較明顯的侵襲性表現b，骨膜增生顯著c，軟組織腫塊較大，患者年齡較大，疼痛繼續加重，腫瘤忽然生長迅速.CT椎體局限性膨脹性溶骨性破壞,皮質延續假設為侵襲性可進犯數個椎體椎弓椎間盤，皮質破壞，軟組織腫塊構成發生于骶骨時，普通位于骶髂關節附近，皮質可中斷加強掃描低密度區散在強化MRIT1WI上呈

15、低、中等信號；T2WI上呈不均勻中等信號。可見部分出血信號加強后明顯強化核素掃描顯示腫瘤呈彌漫性的濃聚骨巨細胞瘤 影像表現.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 contrast agent. FigC

16、 the lesion has only intermediate signal intensity, 28,yr,FGCT of T-3 and T-4Sag.T1WIAxi.T1WI +cSag.T2WIACBT4骨巨細胞瘤.Intraoperative photograph obtained after incision of the skin shows a bulging, solid paraspinal mass (*) FigD骨巨細胞瘤.sacral GCT.A-PLateraLFig AFig b.Axial CTSag.T2WI soft-tissue extension

17、.Cor.T2WIFig CFig DFig EFig F骨巨細胞瘤.GCT of S4-521 yr ,FA-PLateraLAB骨巨細胞瘤.FigC:CTshowing 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 lo

18、w signal intensity; the large presacral mass displacing the rectum is confirmed. FigF:revealing only mild enhancement, again with several areas of relatively low signal intensity. These low-signal regions represent a common feature in GCTsCDEFAxial CTSag. T1WIAxi. FSE T2WISag. FS T1WI +C骨巨細胞瘤.Upper

19、Left: Anteroposterior radiograph emonstrating the expanded 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 th

20、e expansive lesion. Center Right: Sagittal T1-weighted MR image (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

21、 sacrum.骨巨細胞瘤.GCT of C-7 posterior elements 16 y male骨巨細胞瘤.TI 骨巨細胞瘤.骨樣骨瘤Osteoid Osteoma.骨樣骨瘤 臨床病理由成骨性纖維組織及骨樣組織、編織骨構成，腫瘤本身為瘤巢直徑約1.5cm，很少超越2厘米,周圍由增生致密的反響性骨質包繞 10%發生于脊柱，多腰椎，最常起于椎弓，其次椎板，小關節面和椎弓根單發性，腫瘤開展極慢 多為青少年和成年人，多男性，多小于30歲患骨疼痛，夜間加重，服用水楊酸類藥物可緩解為其特點。患者因肌肉痙攣而引起側彎治療以用手術切除最為適宜,預后良好.骨樣骨瘤 影像表現X線腫瘤所在部位骨質破壞周圍

22、不同程度的反響性骨硬化偶見內鈣化/骨化分皮質型、松質型、骨膜下型.骨樣骨瘤 影像表現CT類圓形的低密度骨破壞區，中央見不規那么的鈣化骨化影周圍不同程度的反響性骨硬化環MRI 腫瘤未鈣化部分T1WI呈低至中等信號，T2WI呈高信號 鈣化及周圍硬化帶均呈低信號 加強后，病變強化明顯。核素掃描腫瘤顯示明顯核素濃聚.FigA: Radiograph reveals a subtle lucent area (arrow) in a right articular mass.FigB: CT scan shows the nidus (large arrowheads) with a small cen

23、tral area of calcification (small arrowhead) and minimal surrounding sclerosis. FigC: Radiograph of the resected specimen shows that the nidus was entirely removed (arrows).FigD: Posterior bone scan shows intense uptake of the radionuclide by the nidus (arrow) 17, yr, M Osteoid osteoma of lamina at

24、T-11 ABCD骨樣骨瘤瘤巢.FigE: Photograph of the gross specimen reveals the nidus (*)extending to the facet cartilage (arrows)骨樣骨瘤瘤巢.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. Axi

25、al CT scan (right) demonstrating that left hemilaminectomy was sufficient to remove the tumor.16, yr, M Osteoid osteoma of lamina at C-5 骨樣骨瘤.骨母細胞瘤Osteoblastoma.骨母細胞瘤 臨床病理多量骨母細胞增生構成骨樣組織和編織骨為特點。典型病變直徑為1.5cm2cm不等腫瘤境界清楚，血管豐富，腫瘤體積較大時出現囊變，合并動脈瘤樣骨囊腫時那么多數含血囊腔。少數腫瘤可發生惡變約3040%發生于脊柱,頸椎、胸椎和腰椎發病率相近,腫瘤常累及附件男性多于女

26、性，男:女2:1，發病年齡90% 2030歲患骨部分疼痛不適，脊髓和神經壓迫病癥。水楊酸類藥物無緩解和無明顯夜間疼痛與骨樣骨瘤鑒別。治療應手術切除，病變復發率為10-15%.X線三種表現a：中心低密度破壞區，周圍骨硬化，病灶直徑大于1.5cmb：有多發小鈣化的膨脹性破壞，周圍伴硬化緣c：為侵襲性表現，骨膨脹破壞，及周圍軟組織浸潤 和混雜性鈣化骨母細胞瘤 影像表現.CT對腫瘤內鈣/骨化影顯示高于平片,尤其對復雜部位腫瘤顯示較好類圓形膨脹性骨質破壞，周圍有不同程度增生硬化破壞區骨殼可中斷, 周圍軟組織可局限性腫脹MRI非鈣/骨化部分T1WI呈低至中等信號,T2WI呈高信號, 鈣/骨化部分呈低信號病

27、灶周圍骨髓和軟組織反響性充血水腫，為長T1長T2信號可顯示骨殼中斷，椎管內延伸和脊髓受壓合并動脈瘤樣骨囊腫時可見囊腔及液液平面 核素掃描腫瘤顯示明顯核素濃聚 骨母細胞瘤 影像表現.Fig.Ashows a markedly expansile lesion involving the spinous process and laminae (arrows), with vague sclerosis suggestive of mineralization. Fig.BCT scan reveals the marked expansion of the lesion, which has a

28、 defined sclerotic rim (arrows), and its encroachment on the spinal canal. Matrix mineralization (arrowheads), 16, yr, M. osteoblastoma of C-3 Fig.A L radiographFig.B CT骨母細胞瘤.Axi. T1WI FigC and Sag. T2WI FigD show the mass (arrows) and its degree of encroachment on the spinal canal (arrowheads in c)

29、. Because of its extensive mineralization, the mass has relatively low signal intensity on the T2-weighted image. Axi. T1WISag. T2WIFigCFigD:骨母細胞瘤.FigE骨母細胞瘤.FigA: CT scan shows a destructive, expansile lesion of the left lateral side of C-1 (arrows) with small foci of mineralized matrix peripherally

30、 (arrowheads) and invasion of the surrounding soft tissues 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 (curv

31、ed arrow). 9, yr, M. Aggressive osteoblastoma of C1ABC骨母細胞瘤 (侵襲性)CTMRIDSA.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 osteoblast

32、oma of S4-5 骨母細胞瘤.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 骨母細胞瘤.Lateral x-ray films (a)

33、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-2 body. Technetium b

34、one 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 (i) showing

35、 solid fusion.10, yr, M osteoblastoma of C2 骨母細胞瘤.動脈瘤樣骨囊腫Aneurysmal Bone Cyst, ABC.動脈瘤樣骨囊腫 臨床病理緣由不明的腫瘤樣病變，分原發和繼發兩種病變由大小不等的海綿狀血池組成，外壁為薄壁囊狀骨殼繼發者發生原有病變根底上，包括骨巨細胞瘤、骨母細胞瘤、軟骨母細胞瘤和骨肉瘤等好發于青少年，多1020歲，女性略多脊柱占12-30，胸椎最常受累，其次腰椎和頸椎，骶骨稀有；病變位于椎弓及其突起臨床病癥主要為病變進犯椎管引起相應部位疼痛和神經壓迫病癥可行刮除植骨術，還可栓塞治療和放療；總的復發率為20-30%。 .動脈瘤樣骨

36、囊腫 影像表現X線典型表現為脊柱附件骨顯著膨脹的囊狀透亮區，外側為薄的骨殼，呈“氣球狀囊內有或粗或細的骨小梁狀分隔或骨嵴.動脈瘤樣骨囊腫 影像表現CT多呈囊狀膨脹性骨破壞，骨殼菲薄軟組織密度腫塊內見斑片樣、條索狀及不定形鈣化，邊緣可有硬化有時可見液液平面，下部密度高于上部，隨體位而改動。MRI檢出液液平面更敏感液液平面是本病的重要特點，T2WI上層普通為高信號，能夠為漿液或高鐵血紅蛋白，下層為低信號，能夠有含鐵血黃素成分。核素掃描常表現為外周部位的核素攝取添加，呈“油炸圈餅征.Fig.A and after Fig.B administration of gadopentetate dimeg

37、lumine 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 lesion contains fluid-

38、fluid levels (arrows) resulting from hemorrhagic spaces and shows the extent of spinal canal narrowing. 8yr, M ABC of T3ABC動脈瘤樣骨囊腫T1WI C+T1WIT2WI液-液平面(血竇).Photograph of the sagittally sectioned gross specimen demonstrates the multiple blood-filled spaces (arrows) in the lesion. Fig.D血竇動脈瘤樣骨囊腫.Fig.A

39、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 posterior elements (arrows)Fig.CThe lesion is more readily seen on the CT scan obtained with the patient in a pron

40、e 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 the lesion actually represent fluid levels. Fig.DFluid levels (short arrow) are more readily observed on a

41、 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 signal intensity portion of the fluid is blood. Most, but not all, ABCs contain fluid levels. Converse

42、ly, 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 the fluid levels that is solid (long arrows). 14, yr, M ABC of SADCB液-液平面(血竇)動脈瘤樣骨囊腫.neurysmal

43、 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 vertebral body from the left. This process with a thin periosteal border enters the spinal canal, pressing the cord forward and to the right Fig.B Ma

44、gnetic resonance imaging after injection with gadolinium shows a nonhomogeneous multilobular lesion at T10-T12 level, extradurally pressing the spinal cord forward and to the right, destroying the pedicle and the lamina of the vertebra. Fig.AFig.B動脈瘤樣骨囊腫T1WI C+.骨嗜酸性肉芽腫Eosinophilic Granuloma.骨嗜酸性肉芽腫

45、臨床病理本病屬網狀內皮系統類脂質堆積病，稱朗罕氏細胞組織細胞病Langerhans cell histiocytosis包括三種病變：勒雪病、韓薛柯病和嗜酸性肉芽腫。其孤立方式為嗜酸性肉芽腫，為良性局限性組織細胞增生，為最輕型。椎體為主要原發部位，多單發，可多發。肉芽組織位于骨髓腔伴出血壞死和囊變；晚期常有結締組織增生，纖維化骨化好發于兒童及青年，男多于女患部細微疼痛，壓痛， 伴有功能妨礙治療方案：保守治療、固定、刮除、瘤內注射激素，放療和切除等.骨嗜酸性肉芽腫 影像表現 生長迅速的溶骨性病變，常導致椎體變扁和硬化，稱扁平椎。平片即可容易診斷，CT及MRI對確定病變范圍很有協助病變延伸到周圍軟

46、組織時，CT及MRI不典型，需組織學證明.vertebra plana can be seen (arrow) in the thoracic spine, which is consistent with Langerhans cell histiocytosis.8, yr, M of T扁平椎骨嗜酸性肉芽腫.內生骨疣Enostosis .內生骨疣 臨床病理內生骨疣通常指骨島，也稱鈣化性骨髓缺損、內生骨瘤組織學上骨疣為板層骨，哈佛氏系統包埋在髓管內。病變較出生時進展，并被以為也會產生損害的病變。好發于中軸骨傾向，特別是骨盆、脊柱和肋骨。脊柱骨島發生率僅1%。尸檢14%脊柱內生骨疣好發于胸椎

47、(T1T7)和腰椎L2和L3，胸椎病變常位于中線右側，而腰椎常位于中線左側。病變常位于皮質下，其周圍經常伴有放射狀骨針。病變大小約2mmX2mm 到6mmX10mm，大于2cm為宏大內生骨疣常無病癥，偶爾發現.內生骨疣 影像表現X線平片和CT常具有特征性表現，為圓形或橢圓構成骨性病變，邊境清楚,邊緣呈“棘狀放射征或“毛刷狀邊緣。周圍骨小梁正常MRI在各序列均為低信號，棘狀邊緣顯示清楚。周圍骨髓信號正常核素掃描絕大多數內生骨疣顯示為正常，無異常放射性核素濃聚。少數出現濃聚的病變通常為宏大內生骨疣，占33病變自然病史不同，絕大多數病變變化不大，部分可緩慢生長或體積減小31.9。6個月內病變直徑添加

48、25%或1年內50%時應思索該病.Fig.A Lateral radiograph shows a sclerotic focus in the anterior 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.

49、B內生骨疣毛刷狀邊緣.Fig.A Lateral radiograph reveals 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 eno

50、stosis of L-2Fig.BFig.B. 脊柱惡性腫瘤 Malignant Tumor.脊柱惡性腫瘤脊索瘤轉移性骨腫瘤骨髓瘤軟骨肉瘤骨肉瘤未分化網狀細胞肉瘤和PNET淋巴瘤 白血病綠色瘤其它：間質軟骨肉瘤、纖維肉瘤均稀有.脊索瘤 Chordoma.脊索瘤 臨床病理少見，來源于脊索剩余，占骨病變不到4%50%于骶骨主要S4-S5，其次35%斜坡，15%椎體主要C2.也為骶骨最常見的原發骨腫瘤 腫瘤呈分葉狀，有纖維假包膜，內含灰白或淺黃色膠狀物；可出血、假囊腔以及肉芽樣組織腫瘤生長緩慢，部分侵襲性，不轉移,偶遠處轉移, 主要為肺、淋巴結、蛛網膜下腔和脊髓多男性，男：女=2-3 :1；30-

51、60歲，頂峰年齡50歲病癥多由腫瘤擴展進犯或壓迫臨近重要組織或器官所引起治療以手術切除為主.脊索瘤 影像表現X線腫瘤為溶骨性破壞，伴大的軟組織腫塊骶椎患骨常膨脹，瘤內50-70%見鈣化鈣化多無定形，位于病變周圍骶椎以上節段患骨較少膨脹改動，并可出現硬化呈“象牙椎表現.脊索瘤 影像表現CT主要呈溶骨性破壞腫瘤分葉狀，囊實性混雜密度，可見不規那么鈣化軟組織腫塊加強，輕至中度強化不易與轉移瘤鑒別.脊索瘤 影像表現MRT1WI：中等信號占75% ；低信號占25% T2WI：呈高信號，信號高于CSF加強：明顯強化MRI在顯示病變侵及的范圍方面優于CTCT在確定腫瘤的性質特點方面優于MRI.Fig.ALa

52、teral 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.Fig.C T1WI Sagittal and ax

53、ial T2WI Fig.DMR images reveal the expansile sacrococcygeal lesion (arrowheads), which has high signal intensity on D. Fig.CFig.D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). Th

54、e upper sacrum (*) is spared脊索瘤.Fig.ALateral radiograph shows a dense vertebral body (arrows) at L-3. Fig.BSagittal reconstructed CT scan obtained after initial open biopsy reveals not only the L-3 sclerosis but also similar findings in the superior aspect of L-4 (arrowheads). Chordoma of L 13-year-

55、old man1-yr history of intermittent low back pain.Fig.AFig.B脊索瘤.Sagittal T1WI Fig.Cand T2WIFig.D MR images better delineate the marrow involvement at L-3 and L-4 with extension through the disk (arrows). The mass has marked high signal intensity on d. Fig.CFig.D.Fig.Egross specimen depicts the exten

56、t 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.Upper Left and Right: Axial CT scans demonstrating a large soft-tissue mass extending anteriorly to involve the rectum and posteriorly to invade the buttocks; calc

57、ification 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 presacral region, extending to surround the rectum and the perivesical fat but not invading the bladder. 24-yr Mchordoma involving S3

58、-5脊索瘤. Fig. A and B: Preoperative axial CT scan and MR image revealing a sacral chordoma. Fig. C: Photograph of a hemisection of gross pathological specimen demonstrating complete en block resection of the sacrum. Fig. D and E: Postoperative anteroposterior and lateral radiographs.Fig.脊索瘤.chordomaFi

59、g.AFig.B脊索瘤. 轉移性骨腫瘤 Secondary Tumoror Metastatic Tumor. 臨床病理脊柱轉移常見轉移途徑主要是血行轉移，少數直接蔓延原發腫瘤常包括：前列腺癌、腎癌、甲狀腺癌、乳癌、肺癌和鼻咽癌等。骨肉瘤、尤文瘤和淋巴瘤也可發生骨轉移患者5160歲最多臨床表現為疼痛、繼續性、夜間加重。可出現腫塊、病理骨折和壓迫病癥治療可選用對原發瘤有效的化學治療(包括激素)和中藥治療，放療可試用于單發轉移轉移性骨腫瘤.轉移性骨腫瘤 影像表現X線分為溶骨型、成骨型和混合型溶骨型：椎體廣泛或局限性骨質破壞，椎體常變扁，椎間隙多堅持完好。椎弓根常受侵蝕破壞成骨型：少見。大多前列腺癌

60、引起，少數為乳癌、鼻咽癌、肺癌和膀胱癌。呈斑片狀、結節狀高密度，位于松質骨內，邊境清楚或不清。骨皮質多完好，骨輪廓多無改動混合型轉移兼有溶骨型和成骨型轉移的骨質改動.轉移性骨腫瘤 影像表現CT較X線敏感能顯示部分軟組織腫塊的范圍、大小及臨近臟器的關系溶骨型為松質骨和或皮質骨的低密度缺損區，常伴軟組織腫塊成骨型為松質骨內斑點狀、片狀、棉團狀或結節狀邊緣模糊的高密度灶，普通無軟組織腫塊混合型兼有兩者改動MRI能檢出X線CT甚至核素顯像不易發現的病灶多數腫瘤T1WI呈低信號，T2WI呈程度不高的高信號脂肪抑制序列顯示更清楚.Magnetic resonance imaging study of th