脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理-002

脊椎轉(zhuǎn)移瘤MR診斷及鑒別診斷脊椎轉(zhuǎn)移瘤MR診斷及鑒別診斷1脊椎轉(zhuǎn)移瘤臨床特點(diǎn)原發(fā)病灶肺癌、乳腺癌、腎癌、胃癌、甲狀腺癌、前列腺癌、鼻咽癌、肝癌、直腸癌、神經(jīng)母細(xì)胞瘤好發(fā)于中老年人癥狀和體征病變脊椎逐漸加重的疼痛,數(shù)月內(nèi)劇痛難忍病變部脊椎不同程度的壓痛脊髓和神經(jīng)根壓迫癥狀(截癱、痛覺過敏)少數(shù)局部觸及韌或硬性腫塊脊椎轉(zhuǎn)移瘤2脊椎轉(zhuǎn)移瘤MR特點(diǎn)好發(fā)于胸腰椎,其次為頸椎和骶骨多脊椎發(fā)病(103例中,多發(fā)101例,單發(fā)2例)多累及椎體后部,常侵犯相鄰椎弓根(3/4)椎體靜脈自后方出椎體椎體靜脈與Bason椎靜脈叢廣泛吻合Bason椎靜脈叢血流緩慢,缺乏靜脈瓣,與胸腹腔靜脈廣泛吻合靜脈逆行轉(zhuǎn)移成為常見途徑脊椎轉(zhuǎn)移瘤3脊椎轉(zhuǎn)移瘤MR特點(diǎn)1/4僅累及椎體極少數(shù)僅累及附件椎體內(nèi)病灶單個(gè)或多個(gè)圓形、卵圓形或不規(guī)則形,邊界較清晰或略模糊可占據(jù)椎體大部或全部脊椎轉(zhuǎn)移瘤4脊椎轉(zhuǎn)移瘤MR特點(diǎn)椎體內(nèi)病灶少數(shù)可伴椎體(壓縮或未壓縮)后緣局限性膨隆椎體壓縮骨折大部信號(hào)異?；蛉啃盘?hào)異常椎體前后徑增加脊椎轉(zhuǎn)移瘤5脊椎轉(zhuǎn)移瘤MR特點(diǎn)壓縮椎體上和(或)下緣中部變扁凹陷明顯后和(或)前緣弧形向外隆突極少數(shù)壓縮椎體(5%呈輕度楔狀變形附件病灶多(45)單側(cè)或雙側(cè)椎弓根及椎體相鄰部分同時(shí)受累外形多有增大脊椎轉(zhuǎn)移瘤6脊椎轉(zhuǎn)移瘤M特點(diǎn)軟組織腫塊矢狀位:以病變脊椎為中心矢狀位:上下范圍多小于或略超過病椎體高度彌漫型(橫軸位):約占1/3,腫塊超過同層面椎體周長1/2,最大厚度小于2cm局限型(橫軸位):約占2/3,腫塊沿椎周延伸長度小于同層面椎體邊緣長度的1/2脊椎轉(zhuǎn)移瘤7脊椎轉(zhuǎn)移瘤MR特點(diǎn)軟組織腫塊局限型多位于一側(cè)椎體和附件的交界處,腫塊厚度1cm~7cm不等少數(shù)腫塊局限于病椎水平椎管內(nèi),呈與椎體或附件相貼的新月形脊椎病灶和軟組織腫塊信號(hào)(缺乏特征性)TIWI多呈低信號(hào)T2WI多為高、低或混雜信號(hào)T2WI脂肪抑制像呈高信號(hào)脊椎轉(zhuǎn)移瘤8脊椎轉(zhuǎn)移瘤MR特點(diǎn)脊椎病灶和軟組織腫塊信號(hào)T2WI為高、低或混雜信號(hào)T2WI脂肪抑制像亦呈高信號(hào)極少數(shù)TW呈等或高信號(hào)增強(qiáng)掃描輕中度均勻或不均勻強(qiáng)化等或略低于正常椎體信號(hào)內(nèi)見類囊狀或不規(guī)則無強(qiáng)化區(qū)脊椎轉(zhuǎn)移瘤9ILTIWI2WIT2WIFATSATIL10脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00211脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00212脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00213脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00214脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00215脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00216脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00217脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00218脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00219脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00220脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00221脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00222脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00223脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00224脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00225脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00226脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00227脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00228脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00229脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00230脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00231脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00232脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00233脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00234脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00235脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00236脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00237脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00238脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00239脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00240脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00241脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00242脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00243脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00244脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00245脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00246脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00247脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00248脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00249脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00250脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00251脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00252脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00253脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00254脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00255脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00256脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00257脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00258脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00259脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00260脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00261脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00262脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00263脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00264脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00265脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00266脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00267脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00268脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00269脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00270脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00271脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00272脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00273脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00274脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00275脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00276脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00277脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00278脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00279脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00280脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00281脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00282脊椎轉(zhuǎn)移瘤MR診斷及鑒別診斷脊椎轉(zhuǎn)移瘤MR診斷及鑒別診斷83脊椎轉(zhuǎn)移瘤臨床特點(diǎn)原發(fā)病灶肺癌、乳腺癌、腎癌、胃癌、甲狀腺癌、前列腺癌、鼻咽癌、肝癌、直腸癌、神經(jīng)母細(xì)胞瘤好發(fā)于中老年人癥狀和體征病變脊椎逐漸加重的疼痛,數(shù)月內(nèi)劇痛難忍病變部脊椎不同程度的壓痛脊髓和神經(jīng)根壓迫癥狀(截癱、痛覺過敏)少數(shù)局部觸及韌或硬性腫塊脊椎轉(zhuǎn)移瘤84脊椎轉(zhuǎn)移瘤MR特點(diǎn)好發(fā)于胸腰椎,其次為頸椎和骶骨多脊椎發(fā)病(103例中,多發(fā)101例,單發(fā)2例)多累及椎體后部,常侵犯相鄰椎弓根(3/4)椎體靜脈自后方出椎體椎體靜脈與Bason椎靜脈叢廣泛吻合Bason椎靜脈叢血流緩慢,缺乏靜脈瓣,與胸腹腔靜脈廣泛吻合靜脈逆行轉(zhuǎn)移成為常見途徑脊椎轉(zhuǎn)移瘤85脊椎轉(zhuǎn)移瘤MR特點(diǎn)1/4僅累及椎體極少數(shù)僅累及附件椎體內(nèi)病灶單個(gè)或多個(gè)圓形、卵圓形或不規(guī)則形,邊界較清晰或略模糊可占據(jù)椎體大部或全部脊椎轉(zhuǎn)移瘤86脊椎轉(zhuǎn)移瘤MR特點(diǎn)椎體內(nèi)病灶少數(shù)可伴椎體(壓縮或未壓縮)后緣局限性膨隆椎體壓縮骨折大部信號(hào)異?；蛉啃盘?hào)異常椎體前后徑增加脊椎轉(zhuǎn)移瘤87脊椎轉(zhuǎn)移瘤MR特點(diǎn)壓縮椎體上和(或)下緣中部變扁凹陷明顯后和(或)前緣弧形向外隆突極少數(shù)壓縮椎體(5%呈輕度楔狀變形附件病灶多(45)單側(cè)或雙側(cè)椎弓根及椎體相鄰部分同時(shí)受累外形多有增大脊椎轉(zhuǎn)移瘤88脊椎轉(zhuǎn)移瘤M特點(diǎn)軟組織腫塊矢狀位:以病變脊椎為中心矢狀位:上下范圍多小于或略超過病椎體高度彌漫型(橫軸位):約占1/3,腫塊超過同層面椎體周長1/2,最大厚度小于2cm局限型(橫軸位):約占2/3,腫塊沿椎周延伸長度小于同層面椎體邊緣長度的1/2脊椎轉(zhuǎn)移瘤89脊椎轉(zhuǎn)移瘤MR特點(diǎn)軟組織腫塊局限型多位于一側(cè)椎體和附件的交界處,腫塊厚度1cm~7cm不等少數(shù)腫塊局限于病椎水平椎管內(nèi),呈與椎體或附件相貼的新月形脊椎病灶和軟組織腫塊信號(hào)(缺乏特征性)TIWI多呈低信號(hào)T2WI多為高、低或混雜信號(hào)T2WI脂肪抑制像呈高信號(hào)脊椎轉(zhuǎn)移瘤90脊椎轉(zhuǎn)移瘤MR特點(diǎn)脊椎病灶和軟組織腫塊信號(hào)T2WI為高、低或混雜信號(hào)T2WI脂肪抑制像亦呈高信號(hào)極少數(shù)TW呈等或高信號(hào)增強(qiáng)掃描輕中度均勻或不均勻強(qiáng)化等或略低于正常椎體信號(hào)內(nèi)見類囊狀或不規(guī)則無強(qiáng)化區(qū)脊椎轉(zhuǎn)移瘤91ILTIWI2WIT2WIFATSATIL92脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00293脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00294脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00295脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00296脊柱轉(zhuǎn)移瘤的診斷和鑒別診斷課件整理_00297脊柱轉(zhuǎn)移瘤的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