脊柱肿瘤和肿瘤样病变课件-2.ppt

1、123456789101112131415T1216171819FigA:Radiograph reveals a subtle lucent area(arrow)in a right articular mass.FigB:CT scan shows the nidus(large arrowheads)with a small central area of calcification(small arrowhead)and minimal surrounding sclerosis.FigC:Radiograph of the resected specimen shows that

2、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 T-11 202122232425262728Fig.A L radiographFig.B CT29Fig.D Sag.T2WIFig.C Axi.T1WI3031Lateral x-ray films(a)showed a soft-tissue swelling in t

3、he 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 bone scan(e)also displays pronounced uptake

4、 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 solid fusion.10,yr,M osteoblastoma of C2 32333435363

5、7383940 Chordoma4142434445Fig.ALateral 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46

6、Fig.C T1WI Sagittal and axial T2WI Fig.DMR images reveal the expansile sacrococcygeal lesion (arrowheads),which has high signal intensity on D.Fig.CFig.D脊索瘤脊索瘤47Fig.E As seen in this sagittal section of the gross specimen,the MR imaging appearance correlates with the expansile lesion(arrowheads)and

7、calcification(arrow).The upper sacrum(*)is spared脊索瘤48Upper Left and Right:Axial CT scans demonstrating a large soft-tissue mass extending anteriorly to involve the rectum and posteriorly to invade the buttocks;calcification is seen within the mass.Lower Left and Right:Sagittal fast spin echo T2-wei

8、ghted 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 S3-5脊索瘤49chordomaFig.AFig.B脊索瘤脊索瘤50残存椎间盘形成的“分节”现象51Fig.ALateral radiograph shows a dense ve

9、rtebral 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-old man1-yr history of intermittent low back pain.Fig.AFig.B脊索瘤52Sagittal T1W

10、IFig.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.D53Fig.Egross specimen depicts the extent of the neoplasm,with diffuse involvement of L-3(arrowheads),the adjacent disk

11、(*),and the superior aspect of L-4(arrows).Fig.E脊索瘤545556575859606162Fig.Multiple plasmacytomas with cord compression.a Sagittal T1WI(left)andbSTIR(right)MRI of thoracic spine show scattered focal lesions involving vertebral bodies and posterior elements of thoracic spine.Bothc transverse and sagitt

12、al(a,left)MRI show cord compression by a focal expansile mass(arrow)at the T10 spinous process.abc63Myeloma of T5-T764 T1WI STIR T2WI STIR65666768sclerotic metastases697071Figure.Sagittal T1-weighted MR image of the lumbosacral spine shows multiple hypointense foci within the sacrum and lumbar verte

13、brae.These lesions remained hypointense with all of the MR imaging sequences and did not exhibit enhancement.Plain radiography revealed sclerotic metastases.77-yr FMetastatic breast cancer72Fig.A:Sagittal T2-weighted MR image demonstrating involvement of the posterior elements of L-3(arrow).Fig.B:Ax

14、ial T1-weighted MR image revealing the L-3 spinous process and lamina infiltrated by tumor,with anterior structures intact(arrow).Fig.c:Bone scan demonstrating numerous additional sites of metastatic disease(ribs,skull,and scapula)in addition to L-3(arrow).The patient underwent simple posterior decompression.54-yr Mmetastatic renal cell carcinomaABC7374757677787980818283848586878889vertebra plana can be seen(arrow)in the thoracic spine,which is consistent with Langerhans cell histiocytosis.8,yr,M of T9091929394959697Thank You98