脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件

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(jué)過(guò)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(jiàn)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脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件6脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件7脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件8脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件9脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件10脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件11脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件12脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件13脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件14脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件15脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件16脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件17脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件18脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件19脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件20脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件21脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件22脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件23脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件24脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件25脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件26脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件27脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件28脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件29脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件30脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件31脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件32脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件33脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件34脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件35脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件36脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件37脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件38脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件39脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件40脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件41脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件42脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件43脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件44脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件45脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件46脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件47脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件48脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件49脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件50脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件51脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件52脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件53脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件54脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件55脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件56脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件57脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件58脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件59脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件60脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件61脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件62脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件63脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件64脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件65脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件66脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件67脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件68脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件69脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件70脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件71脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件72脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件73脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件74脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件75脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件76脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件77脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件78脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件79脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件80脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件81脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件82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(jué)過(guò)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(jiàn)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)異常或全部信號(hào)異常椎體前后徑增加脊椎轉(zhuǎn)移瘤87脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件88脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件89脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件90脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件91脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件92脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件93脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件94脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件95脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件96脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件97脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件98脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件99脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件100脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件101脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件102脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件103脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件104脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件105脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件106脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件107脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件108脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件109脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件110脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件111脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件112脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件113脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件114脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件115脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件116脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件117脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件118脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件119脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件120脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件121脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件122脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件123脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件124脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件125脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件126脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件127脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件128脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件129脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件130脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件131脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件132脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件133脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件134脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件135脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件136脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件137脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件138脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件139脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件140脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件141脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件142脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件143脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件144脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件145脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件146脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件147脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件148脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件149脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件150脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件151脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件152脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件153脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件154