轉(zhuǎn)移性骨腫瘤(講稿)

1、 臨床病理脊柱轉(zhuǎn)移常見(jiàn)轉(zhuǎn)移途徑主要是血行轉(zhuǎn)移，少數(shù)直接蔓延原發(fā)腫瘤常包括：前列腺癌、腎癌、甲狀腺癌、乳癌、肺癌和鼻咽癌等。骨肉瘤、尤文瘤和淋巴瘤也可發(fā)生骨轉(zhuǎn)移患者5160歲最多臨床表現(xiàn)為疼痛、持續(xù)性、夜間加重?？沙霈F(xiàn)腫塊、病理骨折和壓迫癥狀治療可選用對(duì)原發(fā)瘤有效的化學(xué)治療(包括激素)和中藥治療，放療可試用于單發(fā)轉(zhuǎn)移轉(zhuǎn)移性骨腫瘤轉(zhuǎn)移性骨腫瘤 影像表現(xiàn)X線分為溶骨型、成骨型和混合型溶骨型：椎體廣泛或局限性骨質(zhì)破壞，椎體常變扁，椎間隙多保持完整。椎弓根常受侵蝕破壞成骨型：少見(jiàn)。大多前列腺癌引起，少數(shù)為乳癌、鼻咽癌、肺癌和膀胱癌。呈斑片狀、結(jié)節(jié)狀高密度，位于松質(zhì)骨內(nèi)，邊界清楚或不清。骨皮質(zhì)多完整，骨輪

2、廓多無(wú)改變混合型轉(zhuǎn)移兼有溶骨型和成骨型轉(zhuǎn)移的骨質(zhì)改變轉(zhuǎn)移性骨腫瘤 影像表現(xiàn)CT較X線敏感能顯示局部軟組織腫塊的范圍、大小及鄰近臟器的關(guān)系溶骨型為松質(zhì)骨和或皮質(zhì)骨的低密度缺損區(qū)，常伴軟組織腫塊成骨型為松質(zhì)骨內(nèi)斑點(diǎn)狀、片狀、棉團(tuán)狀或結(jié)節(jié)狀邊緣模糊的高密度灶，一般無(wú)軟組織腫塊混合型兼有兩者改變MRI能檢出X線CT甚至核素顯像不易發(fā)現(xiàn)的病灶多數(shù)腫瘤T1WI呈低信號(hào)，T2WI呈程度不高的高信號(hào)脂肪抑制序列顯示更清楚Magnetic resonance imaging study of the spine shows a destructive lesion in the second lumbar ve

3、rtebra with extension into the spinal canal.Abdominal computed tomographic scan shows hepatic metastases and an irregular mass in the region of the pancreas. Fig.AFig.BFig.BFig.Asclerotic metastasesFigure. Sagittal T1-weighted MR image of the lumbosacral spine shows multiple hypointense foci within

4、the sacrum and lumbar vertebrae. 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 cancerFractureFracturestenosismassExtensive osseous metastases from lung carcinoma. Anter

5、ior (left) and posterior (right) wholebodybone scintigrams show multiple, randomly distributed foci of abnormal radiotracer uptake. The focivary in size and intensity.Fig.A : Sagittal T2-weighted MR image demonstrating involvement of the posterior elements of L-3 (arrow). Fig.B : Axial T1-weighted M

6、R image revealing the L-3 spinous process and lamina infiltrated by tumor, with anterior structures intact (arrow). Fig.E : Bone scan demonstrating numerous additional sites of metastatic disease (ribs, skull, and scapula) in addition to L-3 (arrow). The patient underwent simple posterior decompress

7、ion. 54-yr Mmetastatic renal cell carcinomaABCSag.MRI of the lower T and upper T are (A)hypointense on T1WI and (B) hyperintense onT2 WI). On DW EPI (C, b value of 440 sec/mm2; D, b value of 880 sec/mm2), the vertebral metastasis and vertebral compression fractures appear hyperintense.E, ADC map sho

8、ws both vertebral metastasis and acute pathologic vertebral compression fractures with low ADCs, which indicate hindered diffusion of water protons and the pathologic nature of these findings. Note the hyperintense area located centrally in the fracture of L1, which possibly indicates unhindered dif

9、fusion in an area of debris.63-yr Fwith breast Ca.M at L1 (arrows)fractures at T11-12 (arrowheads)50-yr Fbreast carcinomamastectomy 5 yrs earlierLeft: Postoperative plain nteroposterior radiograph obtained after T-2 corpectomy and T1-3 stabilization performed via a median sternotomy approach (note t

10、he sternal wires (arrow) Right: Postoperative axial CT scan demonstrating good spinal decompression, structural iliac crest autograft strut, and an anterior plate. 62-yr Mlarge cell Caof the lung Neuroimages demonstrating reconstruction after C-4 corpectomy for a renal cell metastasis; stabilization

11、 was achieved using a titanium mesh interbody cage and chest tube construct filled with PMMA, supplemented by an anterior cervical plate. Left: Preoperative T2-weighted magnetic resonance image, sagittal view, revealing VB collapse at C-4. Right: Postoperative cervical x-ray film, lateral view. Fig.

12、A Preoperative plain x-ray film showing marked destruction of the C-3 VB and associated kyphotic eformity. Fig.B Postoperative x-ray film showing placement of the TPS device into the C-3 corpectomy defect, restoring anterior column height. Fig.C Illustrations of the TPS device. The apparatus is expa

13、ndable to fit the size of the corpectomy defect and can be filled with bone autograft if desired. Squamous cell carcinoma of the lung metastatic to C-3. ABC五.脊柱病變(轉(zhuǎn)移瘤)MR表現(xiàn)多脊椎發(fā)病易累及椎體后部，常同時(shí)侵犯相鄰椎弓根椎體內(nèi)病灶單發(fā)病灶 圓形、卵圓形或累及椎體大部 邊界清晰或略模糊多發(fā)結(jié)節(jié)病灶 之間為殘留正常骨髓信號(hào) 邊界清晰全椎體信號(hào)異常信號(hào)不特異五.脊柱病變(轉(zhuǎn)移瘤)MR表現(xiàn)椎體邊緣膨隆椎體壓縮見(jiàn)于椎體大部或全部受累者多中

14、部上下緣凹陷前后徑延長(zhǎng)前和（或）后邊緣隆突附件病變可呈現(xiàn)外形粗大五.脊柱病變(轉(zhuǎn)移瘤)MR表現(xiàn)軟組織腫塊出現(xiàn)率39.35%矢狀位圖像：上下范圍局限，以病變椎體為中心較大軟組織腫塊多局限于椎體與附件交界處外側(cè)增強(qiáng)掃描脊椎病灶和軟組織腫塊輕中度均勻或不均勻強(qiáng)化 T1WI T2WI T2WI FAT SATT2WI FAT SATT1WIT1WI T2WI FAT SATT1WI T2WI FAT SAT SAME SLICET2WI FAT SATT1WIT2WI FAT SATT1WIT2WI FAT SAT脊椎轉(zhuǎn)移瘤T2WI FAT SATT2WI FAT SATT1WI T2WI FAT SAT SAME SLICET2WI FAT SATT1WIT2WIT1WIT2WI FAT SAT T1WI T2WI T2WI FAT SAT T1WI T2WI T2WI FAT SATT1WI T2WI FAT SATT1WI T2WI T2WI FAT SATT1WI T2WI T2WI FAT SATT1WIT2WI FAT SAT附件附件附件T1WI T2WI T2WI FAT SAT附件附件T1WI T2WI附件T1WIT2WI