目的：探讨颅颈交界区及可动脊柱脊索瘤的影像表现，以提高对此肿瘤的认识。方法：回顾分析55例病理确诊脊索瘤部位、骨质破坏类型、椎旁及椎管内侵犯情况并与进行病理对照。结果：76%位于颈椎，16%位于颅颈交界区，7%位于腰椎；46例位于骨内，5例位于椎管内，4例位于椎旁；45%骨破坏位于椎体，27%椎体和附件均累及，16%累及枕骨斜坡及C1，2%位于附件；32例伴骨质硬化，5例骨破坏不明显；62%连续累及2个或以上椎体，向椎旁及椎管内侵犯占87%，伴椎间孔扩大占22%，11%呈哑铃形；95%为经典型，去分化型和软骨型占5%。结论：发生于可动脊柱的脊索瘤主要位于颈椎，可侵犯邻近多个椎体，易向椎旁及椎管内侵犯；肿瘤位于椎管内、椎旁、呈哑铃状生长及不伴骨质破坏的脊索瘤相对少见。
Abstract
Objective: To characterize the imaging spectrum of chordoma in the junction of craniocervical spine and mobile spine, so that to improve the understanding of chordoma. Methods: Fifty-five patients pathologically diagnosed with chordoma were reviewed and the following radiologic findings were evaluated including location, type of bone destruction, paraspinal and intraspinal invasion. Imaging appearances were summarized and compared with pathology results. Results: Cervical spine, the junction of cranial and lumbar spine was involved accounting for 76%, 16% and 7% respectively. Forty-six tumors were intraosseous, five cases were intraspinal and four cases were in the perivetebral space. Bone destruction was seen in vertebral body(45%), both vertebral body and posterior attachement(27%), clivus basilaris and C1(16%), and posterior attachement(2%). Thirty-two cases showed bone destruction and osteosclerosis and 5 cases showed no bone destruction. Chordomas tended to extend multilevel segments(62%) and invaded paraspinal and intraspinal space(87%) with enlargement of intervertebral foramen(22%) and showed dumb-bell shape(11%). Typital chordoma was commonly seen accounting for 95% and the rest(5%) was undifferentied and chondroid. Conclusions: Chordoma of mobile spine is commonly seen in the cervical spine and it often involves several spinal segments. Vertebral chordoma shows lytic bone destruction with bone sclerosis and it can invade paraspinal and intraspinal region and very few cases may be in the intraspinal and paraspinal region with foramen enlargement. Dumb-belled chordoma and chordoma without bone destruction are less commonly seen.
关键词
脊索瘤 /
脊柱 /
体层摄影术 /
螺旋计算机 /
磁共振成像
Key words
Chordoma /
Spine /
Tomography, spiral computed /
Magnetic resonance imaging
中图分类号：
Ｒ738.1
Ｒ814.42
Ｒ445.2
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