脊柱腫瘤的影像學(xué)診斷 ppt課件

1、脊柱腫瘤的影像學(xué)診斷1脊柱腫瘤的影像學(xué)診斷脊柱大體解剖脊柱檢查技術(shù)脊柱影像解剖脊柱良性腫瘤和腫瘤樣病變脊柱惡性腫瘤2脊柱大體解剖3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(guān)節(jié)、椎旁韌帶等胸段4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(gòu)成椎間孔椎管:各椎骨的椎孔共同連成頸椎環(huán)椎:前后弓及兩側(cè)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(guān)節(jié)面近呈水

2、平位，鉤椎關(guān)節(jié)（Luscka關(guān)節(jié)）胸椎：逐漸增大，椎孔心形，關(guān)節(jié)突關(guān)節(jié)面呈冠狀位腰椎：椎體逐漸增大，椎孔呈三角形，關(guān)節(jié)突關(guān)節(jié)面呈矢狀位骶骨：骶骨倒立扁三角形，5個骶椎融合而成尾骨:4個尾椎融合而成骨性椎管的特點(diǎn)5骨間連接椎體間連接前縱韌帶、后縱韌帶、椎間盤椎板及附件間連接黃韌帶、棘間韌帶、棘上韌帶、項(xiàng)韌帶橫突間韌帶、關(guān)節(jié)突關(guān)節(jié)環(huán)樞關(guān)節(jié)、環(huán)椎橫韌帶6posteriAnteri7RlateralLlateral8C129C3710T11L1

3、2SCo131415檢查技術(shù)ExaminationMethods16檢查技術(shù)常規(guī)X線:最主要和首選的檢查方法CT:解決臨床和X線診斷疑難的第二步檢查方法MRI:示X線甚至CT不能顯示和顯示不佳的某些組織結(jié)構(gòu)核素掃描:一種全身骨骼檢查，但缺乏特異性17影像解剖RadiologicAnatomy18常規(guī)X線C19T20LAPLateral21Loblique22CT解剖T重建23LCT解剖24MRI解剖C25脊柱良性腫瘤和腫瘤樣病變Beni

4、gnSpinalTumTumlikeLesion26脊柱良性腫瘤和腫瘤樣病變骨血管瘤骨軟骨瘤骨巨細(xì)胞瘤骨樣骨瘤骨母細(xì)胞瘤動脈瘤樣骨囊腫骨嗜酸性肉芽腫內(nèi)生骨疣其它：軟骨黏液樣纖維瘤、纖維骨瘤、血管外皮細(xì)胞瘤和血管內(nèi)皮細(xì)胞瘤等27骨血管瘤Hemangioma28骨血管瘤臨床病理最常見的脊柱原發(fā)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(xì)血管型和海綿狀血管型多胸椎椎體多單椎體病變?nèi)魏文挲g均可發(fā)生，一般無癥狀，多女性對

5、放射線有相當(dāng)?shù)拿舾行?9骨血管瘤影像表現(xiàn)X線一為受累骨體積擴(kuò)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(xiàn)一為受累骨質(zhì)有肥皂泡沫樣的破壞和擴(kuò)張30骨血管瘤影像表現(xiàn)CT椎體部分或全部松質(zhì)骨密度減低病變區(qū)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(xiàn)增強(qiáng)掃描，病變常不強(qiáng)化或輕度強(qiáng)化MRIT1WI和T2WI上均呈高信號增強(qiáng)掃描，中度至明顯強(qiáng)化31PlainfilmCTT骨血管瘤32T骨血管瘤33Fig.Athickenedtr

6、abeculae(cduroysign)ofavertebralbodyhemangiomacanbeseenonthislateralviewwhichisconeddowntotheL2vertebralbodyFig.BT1WIFig.CT2WIshowthetypicalincreasedsignalintensityofavertebralbodyBC骨血管瘤34骨軟骨瘤Osteochondroma35臨床病理由骨質(zhì)組成的基底

7、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(gòu)成又稱外生骨疣發(fā)生于脊椎少見，發(fā)生于脊柱單發(fā)1.3～1.4%，多發(fā)者9%約50%于頸椎，其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(fā)生惡變多兒童和青年男性，一般無癥狀治療應(yīng)徹底手術(shù)切除骨軟骨瘤36骨軟骨瘤影像表現(xiàn)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(nèi)的腫瘤很難診斷15%顯示正常37骨軟骨瘤影像表現(xiàn)CT附件骨性腫塊，皮質(zhì)與椎板皮質(zhì)相連

8、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(zhì)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12cm）則應(yīng)懷疑惡變3838yrMofCHereditarymultipleexostosiswithseveralspinalosteochondromasFigA:LateralradiographofthecervicalspineshowsaC4spinouspro

9、cessosteochondromawithpathognomonicmarrowcticalcontinuitysolidarrow).OsteochondromaatC1isseenasanossifiedregion(openrrow)AxialFigBsagittalFigCreconstructedCTscansrevealctexmarrowoftheosteochondroma(arrows)impingementonth

10、espinalcanalextrinsicerosionofC2(arrowheadsinb)continuitywiththeC1spinousprocess(inc).ABC骨軟骨瘤39SagittalT1weightedFigDT2gradientechoFigEMRimagesrevealthesignalintensityacteristicofyellowmarrowwithintheosteochondromatheimp

11、ressionofthetumonthespinalcanal(arrows)althoughthemarrowcticalcontinuityisnotwellseen.骨軟骨瘤DE40FigF:Photographofthegrossspecimenshowsthemarrowctexoftheosteochondromaasmallcartilagecapatitsperiphery(arrowheads).4135yr，F(xiàn)Ost

12、eochondromaofsacrummalignanttransfmationFigAVaguesclerosis(solidarrows)overtheleftsacrumwideningofthesacroiliacjoint(openarrow).FigA42FigCAxialCTscanshowsthethickcartilagecap(arrows)sacroiliacjointinvasionwhichrepresents

13、malignanttransfmation.FigBConalreconstructedCTscanshowsthectexmarrowcanaloftheosteochondroma(arrows)continuitywiththesacrum(arrowheads).FigBFigC43multiplehereditaryexostoses.Notethatthelargesacrallesionhasnmalctexaswella

14、smarrowarisingfromtheunderlyingbone.Thisappearancedefinesanexostosis.Welookfathickcartilagecaptosuggestdegenerationofanexostosistoachondrosarcoma.Inthiscasethereisnospacefathickcapbecausetheedgeoftheexostosisextendstothe

15、subcutaneoustissue.IfthereisanyquestionMRimagingcandemonstratethecartilagethickness.Inthiscasewerecognizedmultipleexostosesbecauseofthepresenceofsessilelesionsattheanterisuperiiliacspines.10yrMMultiplehereditaryexostoses

16、44骨巨細(xì)胞瘤GiantCellTumGCT45骨巨細(xì)胞瘤臨床病理由軟而脆且易出血的肉芽樣組織所構(gòu)成，無纖維包膜，可出血和壞死組織學(xué)分三級：Ⅰ級為良性，Ⅱ級為過渡類型，Ⅲ級為惡性患者多女性，發(fā)病年齡多2040歲約13發(fā)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(shù)為良性，約25%為惡性臨床癥狀主要為局部疼痛、無力和感覺異常治療多全切治療，若僅刮除術(shù)會出現(xiàn)4060%％復(fù)發(fā)46骨巨細(xì)胞瘤影像表現(xiàn)X線典型呈膨脹性偏心性多房

17、性骨質(zhì)破壞，骨殼較薄，輪廓一般完整，內(nèi)見纖細(xì)骨嵴構(gòu)成分房狀幾點(diǎn)提示惡性a，較明顯的侵襲性表現(xiàn)b，骨膜增生顯著c，軟組織腫塊較大，患者年齡較大，疼痛持續(xù)加重，腫瘤突然生長迅速47骨巨細(xì)胞瘤影像表現(xiàn)CT椎體局限性膨脹性溶骨性破壞皮質(zhì)連續(xù)若為侵襲性可侵犯數(shù)個椎體椎弓椎間盤，皮質(zhì)破壞，軟組織腫塊形成發(fā)生于骶骨時，一般位于骶髂關(guān)節(jié)附近，皮質(zhì)可中斷增強(qiáng)掃描低密度區(qū)散在強(qiáng)化MRIT1WI上呈低、中等信號；T2WI上呈不均勻中等信號。可見局部出血信號增

18、強(qiáng)后明顯強(qiáng)化核素掃描顯示腫瘤呈彌漫性的濃聚48FigAFigBalargeexpansilelesionoftheT4vertebralbody(arrows)withextensionintotheposterielementsofT3T4theposterisofttissues(arrowheads).Thelesionenhancesmarkedlywiththecontrastagent.FigCthelesionhasonl

19、yintermediatesignalintensity28yrFGCTofT3T4Sag.T1WIAxi.T1WIcSag.T2WIACBT4骨巨細(xì)胞瘤49Intraoperativephotographobtainedafterincisionoftheskinshowsabulgingsolidparaspinalmass()FigD骨巨細(xì)胞瘤50sacralGCT.APLateraLFigAFigb51FigCFigDFigEF

20、igF骨巨細(xì)胞瘤52GCTofS4521yrFAPLateraLAB骨巨細(xì)胞瘤53FigC:CTshowinglargemassofSFigD:demonstratinganinhomogeneousmassthatcontainsseveralareasoflowsignalintensity(arrowscontrastthissignaltotheveryhighsignalintensityFigE:revealingthatt

21、helesionisoflowsignalintensitythelargepresacralmassdisplacingtherectumisconfirmed.FigF:revealingonlymildenhancementagainwithseveralareasofrelativelylowsignalintensity.TheselowsignalregionsrepresentacommonfeatureinGCTsAxi

22、alCTSag.T1WIAxi.FSET2WISag.FST1WIC骨巨細(xì)胞瘤54UpperLeft:Anteroposteriradiographemonstratingtheexpedlyticlesionccupyingthesacrum.UpperRightCenterLeft:AxialCTscansobtainedseveralmonthslaterdemonstratingtheratherfeaturelesslytic

23、lesionoccupyingtheentiresacrumwithattemptedthincticalrimunabletocontaintheexpansivelesion.CenterRight:SagittalT1weightedMRimage(TRTE45010msec)demonstratingintensitypresacralsofttissueextensionLowerLeftRight:SagittalT2WIa

24、xialFSET2WIrevealingtheinhomogeneousmixedhighlowsignalintensitymasstypicalofGCT.26yrFGCTofthesacrum.骨巨細(xì)胞瘤55GCTofC7posterielements16ymale骨巨細(xì)胞瘤56TI骨巨細(xì)胞瘤57骨樣骨瘤OsteoidOsteoma58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(gòu)成，腫瘤本身為瘤巢直徑約1.5cm，很少超過

25、2厘米周圍由增生致密的反應(yīng)性骨質(zhì)包繞10%發(fā)生于脊柱，多腰椎，最常起于椎弓，其次椎板，小關(guān)節(jié)面和椎弓根單發(fā)性，腫瘤發(fā)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(diǎn)?；颊咭蚣∪獐d攣而引起側(cè)彎治療以用手術(shù)切除最為適宜預(yù)后良好59骨樣骨瘤影像表現(xiàn)X線腫瘤所在部位骨質(zhì)破壞周圍不同程度的反應(yīng)性骨硬化偶見內(nèi)鈣化骨化分皮質(zhì)型、松質(zhì)型、骨膜下型60骨樣骨瘤影像表現(xiàn)CT類圓形的低密度骨破壞區(qū)，中央見不規(guī)則

26、的鈣化骨化影周圍不同程度的反應(yīng)性骨硬化環(huán)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增強(qiáng)后，病變強(qiáng)化明顯。核素掃描腫瘤顯示明顯核素濃聚61FigA:Radiographrevealsasubtlelucentarea(arrow)inarightarticularmass.FigB:CTscanshowsthenidus(largearrowheads)withasmallcentralarea

27、ofcalcification(smallarrowhead)minimalsurroundingsclerosis.FigC:Radiographoftheresectedspecimenshowsthattheniduswasentirelyremoved(arrows).FigD:Posteribonescanshowsintenseuptakeoftheradionuclidebythenidus(arrow)17yrMOste

28、oidosteomaoflaminaatT11ABCD骨樣骨瘤瘤巢62FigE:Photographofthegrossspecimenrevealsthenidus()extendingtothefacetcartilage(arrows)骨樣骨瘤瘤巢63AxialCTscan(left)revealingthatatumarisingfromtheleftC5pedicleiscompressingtheleftC5root.Bon

29、escan(center)displayshighuptakeofcontrastmaterial.AxialCTscan(right)demonstratingthatlefthemilaminectomywassufficienttoremovethetum.16yrMOsteoidosteomaoflaminaatC5骨樣骨瘤64骨母細(xì)胞瘤Osteoblastoma65骨母細(xì)胞瘤臨床病理多量骨母細(xì)胞增生形成骨樣組織和編織骨為特點(diǎn)。

30、典型病變直徑為1.5cm～2cm不等腫瘤境界清楚，血管豐富，腫瘤體積較大時出現(xiàn)囊變，合并動脈瘤樣骨囊腫時則多數(shù)含血囊腔。少數(shù)腫瘤可發(fā)生惡變約30～40%發(fā)生于脊柱頸椎、胸椎和腰椎發(fā)病率相近腫瘤常累及附件男性多于女性，男:女＝2:1，發(fā)病年齡90%20～30歲患骨局部疼痛不適，脊髓和神經(jīng)壓迫癥狀。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(yīng)手術(shù)切除，病變復(fù)發(fā)率為1015%66骨母細(xì)胞瘤影像表現(xiàn)X線三種表現(xiàn)a：中心低密度破壞區(qū)，

31、周圍骨硬化，病灶直徑大于1.5cmb：有多發(fā)小鈣化的膨脹性破壞，周圍伴硬化緣c：為侵襲性表現(xiàn)，骨膨脹破壞，及周圍軟組織浸潤和混雜性鈣化67骨母細(xì)胞瘤影像表現(xiàn)CT對腫瘤內(nèi)鈣骨化影顯示高于平片尤其對復(fù)雜部位腫瘤顯示較好類圓形膨脹性骨質(zhì)破壞，周圍有不同程度增生硬化破壞區(qū)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灶周圍骨髓和軟組織反應(yīng)性充血水腫，為長T1長T2信號可顯示骨殼中斷，

32、椎管內(nèi)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68Fig.Ashowsamarkedlyexpansilelesioninvolvingthespinousprocesslaminae(arrows)withvaguesclerosissuggestiveofmineralization.Fig.BCTscanrevealsthemarkedexpansionofthelesionwhichhas

33、adefinedscleroticrim(arrows)itsencroachmentonthespinalcanal.Matrixmineralization(arrowheads)16yrM.osteoblastomaofC3Fig.ALradiographFig.BCT骨母細(xì)胞瘤69Axi.T1WIFigCSag.T2WIFigDshowthemass(arrows)itsdegreeofencroachmentonthespin

34、alcanal(arrowheadsinc).BecauseofitsextensivemineralizationthemasshasrelativelylowsignalintensityontheT2weightedimage.Axi.T1WISag.T2WIFigCFigD:骨母細(xì)胞瘤70FigE骨母細(xì)胞瘤71FigA:CTscanshowsadestructiveexpansilelesionoftheleftlaterals

35、ideofC1(arrows)withsmallfociofmineralizedmatrixperipherally(arrowheads)invasionofthesurroundingsofttissuesfamentransversarium.FigB:ConalT2weightedMRimageshowshighsignalintensitywithinthemass(arrows).FigC:Digitalsubtracti

36、onangiogramrevealstumstain(straightarrows)obstructionoftheleftvertebralartery(curvedarrow).9yrM.AggressiveosteoblastomaofC1ABC骨母細(xì)胞瘤(侵襲性)CTMRIDSA72Left:Anteroposteriradiographrevealingasubtlyexpedlesionthatisnearthelineat

37、S45(arrows).Right:AxialCTscandemonstratingbonematrixwithinthelesionnotaggressiveinappearance.16yrMosteoblastomaofS45骨母細(xì)胞瘤73Left:bonescanrevealinganeccentricallylocatedareaofincreaseduptakeinthesacrum.Right:TheCTscandemon

38、stratesaminimallyexpedlesioncontainingdensebonematrixintherightsideofthelowersacrum.16yrM.osteoblastomaofS45骨母細(xì)胞瘤74Lateralxrayfilms(a)showedasofttissueswellingintheretropharyngealspace.Lateral(b)conal(c)MRimagesdemonstra

39、tingtumintheC2bodyasofttissuemassfromC1–6.AxialCTscan(d)demonstratingatypicalosteoidniduswithperitumalscleroticrimontherightsideoftheC2body.Techiumbonescan(e)alsodisplayspronounceduptakeinthisregion.Weperfmedtumexcisionv

40、iaananterolateralretropharyngealapproach(f)occipitocervicalfixationbyusingtwoaxisplatestitaniumwires(g).Lateralxrayfilmsobtainedimmediatelyafter(h)2yearspostsurgery(i)showingsolidfusion.10yrMosteoblastomaofC2骨母細(xì)胞瘤75動脈瘤樣骨

41、囊腫AneurysmalBoneCystABC76動脈瘤樣骨囊腫臨床病理原因不明的腫瘤樣病變，分原發(fā)和繼發(fā)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(fā)者發(fā)生原有病變基礎(chǔ)上，包括骨巨細(xì)胞瘤、骨母細(xì)胞瘤、軟骨母細(xì)胞瘤和骨肉瘤等好發(fā)于青少年，多10～20歲，女性略多脊柱占1230％，胸椎最常受累，其次腰椎和頸椎，骶骨罕見；病變位于椎弓及其突起臨床癥狀主要為病變侵犯椎管引起相應(yīng)部位疼痛和神經(jīng)壓迫癥狀可行刮除植骨術(shù)，還可栓塞治療和放

42、療；總的復(fù)發(fā)率為2030%。77動脈瘤樣骨囊腫影像表現(xiàn)X線典型表現(xiàn)為脊柱附件骨顯著膨脹的囊狀透亮區(qū)，外側(cè)為薄的骨殼，呈“氣球狀”囊內(nèi)有或粗或細(xì)的骨小梁狀分隔或骨嵴78動脈瘤樣骨囊腫影像表現(xiàn)CT多呈囊狀膨脹性骨破壞，骨殼菲薄軟組織密度腫塊內(nèi)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，隨體位而改變。MRI檢出液－液平面更敏感液－液平面是本病的重要特點(diǎn)，T2WI上層一般為高信號，可能為漿液或高鐵血紅蛋白，下層

43、為低信號，可能有含鐵血黃素成分。核素掃描常表現(xiàn)為外周部位的核素攝取增加，呈“油炸圈餅”征79Fig.AafterFig.BadministrationofgadopentetatedimegluminerevealamarkedlyexpansilelesioninvolvingthelaminaeofT3(largearrowheads)encroachingonthespinalcanal(smallarrowheads).Enha

44、ncementoccurslargelyintheperipheryseptationsofthelesion.Fig.CSagittalT2weightedMRimageshowsthattheentirelesioncontainsfluidfluidlevels(arrows)resultingfromhemrhagicspacesshowstheextentofspinalcanalnarrowing.8yrMABCofT3AB

45、C動脈瘤樣骨囊腫T1WICT1WIT2WI液液平面(血竇)80Photographofthesagittallysectionedgrossspecimendemonstratesthemultiplebloodfilledspaces(arrows)inthelesion.Fig.D血竇動脈瘤樣骨囊腫81Fig.ATheanteroposteriradiographcanbeeasilymisreadasnmalbecauseofth

46、eoverlyingbowelgasobscuringthesacrumFig.BAlateralradiographdemonstratesonlyobscurationoftheS3posterielements(arrows)Fig.CThelesionismereadilyseenontheCTscanobtainedwiththepatientinaproneposition.Thisscandemonstratesalyti

47、clesionoccupyingtheleftS3alawithathincticalrimsurroundingthemajityofthelesion.Notethatthemelucentregionsinthecenterofthelesionactuallyrepresentfluidlevels.Fig.DFluidlevels(shtarrow)aremereadilyobservedonasagittalT1weight

48、edMRimagerememberthatthepatientissupineintheimagerthatthefluidlevelsonthesagittalexamwouldthenbeexpectedtoappearverticalasinthiscase.Thehighsignalintensityptionofthefluidisblood.MostbutnotallABCscontainfluidlevels.Conver

49、selymostlesionswithsubstantialfluidlevelsareABCsbutsuchlevelsmayoccurinotherlesionsaswell.Notealsointhiscasethatthereisasubstantialcomponentofthelesionlocatedanterilytothefluidlevelsthatissolid(longarrows).14yrMABCofSADC

50、B液液平面(血竇)動脈瘤樣骨囊腫82neurysmalBoneCystFig.AComputedtomographicscanshowingalyticlesionintheposterielementsofthevertebraeattheT10T12levelwithexpansiontothevertebralbodyfromtheleft.Thisprocesswithathinperiostealbderentersthesp

51、inalcanalpressingthecdfwardtotherightFig.BMagicresonanceimagingafterinjectionwithgadoliniumshowsanonhomogeneousmultilobularlesionatT10T12levelextradurallypressingthespinalcdfwardtotherightdestroyingthepediclethelaminaoft

52、hevertebra.Fig.AFig.B動脈瘤樣骨囊腫T1WIC83骨嗜酸性肉芽腫EosinophilicGranuloma84骨嗜酸性肉芽腫臨床病理本病屬網(wǎng)狀內(nèi)皮系統(tǒng)類脂質(zhì)沉積病，稱朗罕氏細(xì)胞組織細(xì)胞病（Langerhanscellhistiocytosis）包括三種病變：勒－雪病、韓－薛－柯病和嗜酸性肉芽腫。其孤立形式為嗜酸性肉芽腫，為良性局限性組織細(xì)胞增生，為最輕型。椎體為主要原發(fā)部位，多單發(fā)，可多發(fā)。肉芽組織位于骨髓腔伴出血壞

53、死和囊變；晚期常有結(jié)締組織增生，纖維化骨化好發(fā)于兒童及青年，男多于女患部輕微疼痛，壓痛，伴有功能障礙治療方案：保守治療、固定、刮除、瘤內(nèi)注射激素，放療和切除等85骨嗜酸性肉芽腫影像表現(xiàn)生長迅速的溶骨性病變，常導(dǎo)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幫助病變延伸到周圍軟組織時，CT及MRI不典型，需組織學(xué)證實(shí)86vertebraplanacanbeseen(arrow)inthethacicspine

54、whichisconsistentwithLangerhanscellhistiocytosis.8yrMofT扁平椎骨嗜酸性肉芽腫87內(nèi)生骨疣Enostosis88內(nèi)生骨疣臨床病理內(nèi)生骨疣通常指骨島，也稱鈣化性骨髓缺損、內(nèi)生骨瘤組織學(xué)上骨疣為板層骨，哈佛氏系統(tǒng)包埋在髓管內(nèi)。病變較出生時進(jìn)展，并被認(rèn)為也會產(chǎn)生損害的病變。好發(fā)于中軸骨傾向，特別是骨盆、脊柱和肋骨。脊柱骨島發(fā)生率僅1%。尸檢14%脊柱內(nèi)生骨疣好發(fā)于胸椎(T1～T7)和腰椎（

55、L2和L3），胸椎病變常位于中線右側(cè)，而腰椎常位于中線左側(cè)。病變常位于皮質(zhì)下，其周圍常常伴有放射狀骨針。病變大小約2mmX2mm到6mmX10mm，大于2cm為巨大內(nèi)生骨疣常無癥狀，偶然發(fā)現(xiàn)89內(nèi)生骨疣影像表現(xiàn)X線平片和CT常具有特征性表現(xiàn)，為圓形或橢圓形成骨性病變，邊界清楚邊緣呈“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(shù)內(nèi)生骨疣顯示為正常，無異常放射性核素

56、濃聚。少數(shù)出現(xiàn)濃聚的病變通常為巨大內(nèi)生骨疣，占33％病變自然病史不同，絕大多數(shù)病變變化不大，部分可緩慢生長或體積減?。?1.9％）。6個月內(nèi)病變直徑增加25%或1年內(nèi)50%時應(yīng)考慮該病90Fig.ALateralradiographshowsascleroticfocusintheanteriptionofL3(arrowhead).Fig.BCTscanrevealsadenselyscleroticlesionwithanirreg