马尾神经区肿瘤mr诊断探讨

马尾神经区肿瘤mr诊断探讨 马尾神经区肿瘤MR诊断探讨 马尾神经区肿瘤MR诊断探讨 【关键词】 马尾神经 摘要:目的:探讨马尾神经区肿瘤MR的 现特征，提高MR影像诊断及鉴别诊断水平。方法:分析经病理或临 床证实确诊的50例马尾神经区肿瘤的MR表现特征。结果:脂肪瘤 15例中例合并先天畸形，2例可见马尾被包绕，2例无规律，3例MRM 旋转呈矢状位可见蛛网膜下腔于一侧受压变窄。神经鞘瘤13例中有 10例有囊变，增强扫描实质部分强化明显;2例马尾神经鞘MRM旋转 观察示肿瘤上、下方的“脑脊液柱”里“杯口”状截断。神经纤维瘤 7例中3例多发，肿瘤T1WI呈等或低信号，T2WI呈等或稍高信号。 室管膜瘤5例，T1WI呈等或稍高信号，T2WI呈高信号，1例有囊变。 脊膜瘤4例增强扫描呈明显强化，其中1例可见“脊膜尾征”，马尾 显示欠佳。多发转移瘤2例MRM中示马尾神经区多发充盈缺损。胆脂 瘤，副神经节瘤，淋巴瘤及血管瘤各1例，其中胆瘤无强化。结论: MR可清晰显示马尾神经区肿瘤的形态、MR信号特征、与马尾神经的 关系及马尾的各种变化，对其诊断的鉴别诊断有较高价值。 关键 词:椎管肿瘤;马尾;磁共振成像 Exploration the Diagnosis of MR of Cauda Tumors Equina HUANG Xun, WU Che-fu,XIE Qun-xian (The Department of Radiology, Zhanjiang Central People‘s Hospital, Guangdong Zhanjiang 524001, China) Abstract: Objective: In order to improve dingnostic ability,the MR imaging finding of cauda tumors were studied. Method: 50 pathologically clinically confirmed cases of tumors in the cauda area were examined with MR imaging. Results: Lipoma occurred in 15 cases of our series of patients and cases out of the 15 showed congenited defect of various kinds simultaneously,lipoma enclosed the cauda equina in 2 cases,MRM demonstrated extradural lipoma in 3 cases .Among 13 cases of neurinoma there was cystic formatoin 10 cases ,constrast-enhanced images show that the tumas was intensively homogenows with rim enhancement,MRM demonstrated the intradural neurinomas appeared as filling defect and were sharply outline by cerebrospinal fluid in 2cases .7case of neurofribroma were found and there multiple lesions in 3 case .The tumor mass showed hypointense on T1WI and hyper or isointense on T2WI. There were 5 cases of ependymoma ,Ependymoma of the filum showed homogenous hyperintense as sligntly hyperintense on T2WI.There was cystic formation in the mass of one case of ependymoma.There were 4 cases of meningioma .The tumor mass showed homogenous enhancement after contrast enhanced scanning and meningeal tail sign was found in one case.MRM showed multiple small intradural extramedullary nodules in the cauda epuina showing filling defects sharply out-line by CSF in 2 cases .one case of hemangioblastoma showed iso intense on T1WI and hyperintense of T2WI relative to CSF.and it exhibited hemogenous enhancement after Gd-DTPA injection. In addition,one case of paraganioma and lymphoma and cholesteation with MR features was found. Conclusion: The imaging of MR is a very valuable method for the diagnosis and differental diagnosis of tumor in the cauda equina. Key words:Instraspinal neoplasm;Cauda equina;MRI 有作者把来源于脊膜或硬膜外结构及硬膜内转移瘤视为马尾肿 瘤，因为这些肿瘤均可引起马尾神经综合征,1,。我们把位于马尾神 经征区的椎管肿瘤统称为马尾神经区肿瘤。本文总结分析50例马尾 神经区肿瘤的MR表现以及肿瘤与马尾的关系，以提高对马尾神经区 肿瘤的影像学认识，为手术治疗及评估预后提供帮助。 1 材 料和方法1 病例资料:在PACS系统收集2004年2月1日至月31日 (笔者进修期间)50例马尾神经区肿瘤病例，其中男35例，女15 例，年龄8个月至50岁，平均年龄34岁，除10例脂肪瘤，2例转 移瘤及1例淋巴瘤外，余均经手术切除病理证实。2例转移瘤的原发 灶为肺癌，其中1例肺癌脑内转移，随访过程中发现马尾转移;1例 锁骨上淋巴结穿刺证实;1例淋巴瘤经颈部淋巴结穿刺证实为非何杰金淋巴瘤。马尾神经区肿瘤的病分类见表1。 表1 50例马尾神经区肿瘤分类 略2 影像技术:西门子1.5T超导型磁共振成像机，常规采用矢状、 冠状、轴位扫描:SE T1WI(TR300,600ms TE,30ms)间距1mm 矩阵256×256， FSE T2WI(TR300msTE90,0ms)层厚4.0mm。增强扫描:Gd-DTPA 0.1mmol/kg 团注后T1WI扫描,重T2WI(MRM)。FSE(TR4500msTE295ms)层厚3.0m 间距2mm ，矩阵256×256。 2 结果 2.1 脂肪瘤:15例中例合并脊髓栓子，其中10例同时合并骶椎裂、脊膜膨出;13例为不条状或梭形病变;1例腰4/5椎间盘水平类圆形病变;均位于椎管背侧。在T1WI、T2WI均呈高信号，特征表现为压脂扫描病变为低信号。肿块大小不一，马尾从无受压到移位变形。2例出现马尾被包绕，2例可见马尾增粗，紊乱。其中3例MRM冠状面示终池圆形或条形充盈缺损，矢状位可见蛛网膜下隙一侧弧形变窄。 2.2 神经鞘瘤:13例中例为单发，1例为多发，8例位于硬膜内，5例位于神经根处。肿瘤多为类圆形，7例肿瘤内有囊变。肿瘤实质性部分T1WI呈等低信号，T2WI呈等高信号。囊变部分T1WI呈明显低信号，T2WI呈明显高信号。增强扫描后实质部分强化明显，囊变区无强化，MRM旋转观察，可见椎管内类圆形充盗缺损，肿瘤上下方的“脑脊液柱”呈“杯口”状截断，并清晰地显示肿瘤的形态、大小、边缘、肿瘤与圆锥及终丝的关系;囊变部分呈高信号。 2.3 神经纤维瘤:7例均位于硬膜下，其中3例单发，4例多发病例，并伴有神经皮肤的其他表现。T1WI呈等低信号，T2WI呈高信号，增强扫描有不同程度强化。MRM可清晰显示马尾及神经根受压、移位。 2.4 室管膜瘤:5例中2例呈“腊肠”样改变，3例类圆形，1例有囊变。肿瘤信号不均匀，T1WI以等信号为主的混杂信号，T2WI以高信号为主的混杂信号;增强扫描肿瘤实质部分强化。肿瘤因为较大，与马尾及神经根关系显示不清。 2.5 脊膜瘤:4例均位于硬膜内，T1WI呈等稍高信号，T2WI呈等高信号;1例CT显示瘤内有钙化，T1WI、T2WI均呈低信号，增强扫描多呈明显强化。与室管膜瘤一样，瘤体较大，与马尾神经关系显示不清。 2.6 转移瘤:2例均多发结节影，T1WI呈稍高信号，T2WI呈等信号，增强扫描明显均匀强化;MRM 示1例为大小均匀的粟粒状结节影，沿马尾走向呈串珠状，1例示马尾及腰5神经根多个大小不等的结节影，左侧椎间孔扩大。 2.7 其它:淋巴瘤1例，MR示腰1,2水平硬膜内圆锥及马尾增粗，可见伴行结节灶，边界不清。T1WI 呈稍高信息，T2WI为等信号，增强明显。 副神经节瘤1例，位于腰3椎水平，呈圆形，边缘清晰，T1WI、T2WI均匀为高信号，边缘可见低信号环。呈明显均匀强化。血管瘤1例，范围较广泛，位腰3,骶1水平硬膜外及左侧椎间孔，形态不规则，边界清晰、锐利。增强扫描均匀强化。胆脂瘤1例，位腰2,3水平硬下肿块影，大小约5×3cm，椎管扩张明显，T1WI呈稍高信号，T2WI为等信号，边界清晰，增强扫描无强化。 3 讨论 马尾神经区肿瘤在临床上可引腰痛、腿麻等马尾神综合征,4,。本组病例