脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件

脊椎轉(zhuǎn)移瘤MR診斷及鑒別診斷脊椎轉(zhuǎn)移瘤MR診斷及鑒別診斷1脊椎轉(zhuǎn)移瘤臨床特點原發(fā)病灶肺癌、乳腺癌、腎癌、胃癌、甲狀腺癌、前列腺癌、鼻咽癌、肝癌、直腸癌、神經(jīng)母細(xì)胞瘤好發(fā)于中老年人癥狀和體征病變脊椎逐漸加重的疼痛,數(shù)月內(nèi)劇痛難忍病變部脊椎不同程度的壓痛脊髓和神經(jīng)根壓迫癥狀(截癱、痛覺過敏)少數(shù)局部觸及韌或硬性腫塊脊椎轉(zhuǎn)移瘤2脊椎轉(zhuǎn)移瘤MR特點好發(fā)于胸腰椎,其次為頸椎和骶骨多脊椎發(fā)病(103例中,多發(fā)101例,單發(fā)2例)多累及椎體后部,常侵犯相鄰椎弓根(3/4)椎體靜脈自后方出椎體椎體靜脈與Bason椎靜脈叢廣泛吻合Bason椎靜脈叢血流緩慢,缺乏靜脈瓣,與胸腹腔靜脈廣泛吻合靜脈逆行轉(zhuǎn)移成為常見途徑脊椎轉(zhuǎn)移瘤3脊椎轉(zhuǎn)移瘤MR特點1/4僅累及椎體極少數(shù)僅累及附件椎體內(nèi)病灶單個或多個圓形、卵圓形或不規(guī)則形,邊界較清晰或略模糊可占據(jù)椎體大部或全部脊椎轉(zhuǎn)移瘤4脊椎轉(zhuǎn)移瘤MR特點椎體內(nèi)病灶少數(shù)可伴椎體(壓縮或未壓縮)后緣局限性膨隆椎體壓縮骨折大部信號異常或全部信號異常椎體前后徑增加脊椎轉(zhuǎn)移瘤5脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件6脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件7脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件8脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件9脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件10脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件11脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件12脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件13脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件14脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件15脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件16脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件17脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件18脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件19脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件20脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件21脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件22脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件23脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件24脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件25脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件26脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件27脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件28脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件29脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件30脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件31脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件32脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件33脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件34脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件35脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件36脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件37脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件38脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件39脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件40脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件41脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件42脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件43脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件44脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件45脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件46脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件47脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件48脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件49脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件50脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件51脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件52脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件53脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件54脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件55脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件56脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件57脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件58脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件59脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件60脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件61脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件62脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件63脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件64脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件65脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件66脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件67脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件68脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件69脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件70脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件71脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件72脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件73脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件74脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件75脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件76脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件77脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件78脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件79脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件80脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件81脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件82脊椎轉(zhuǎn)移瘤MR診斷及鑒別診斷脊椎轉(zhuǎn)移瘤MR診斷及鑒別診斷83脊椎轉(zhuǎn)移瘤臨床特點原發(fā)病灶肺癌、乳腺癌、腎癌、胃癌、甲狀腺癌、前列腺癌、鼻咽癌、肝癌、直腸癌、神經(jīng)母細(xì)胞瘤好發(fā)于中老年人癥狀和體征病變脊椎逐漸加重的疼痛,數(shù)月內(nèi)劇痛難忍病變部脊椎不同程度的壓痛脊髓和神經(jīng)根壓迫癥狀(截癱、痛覺過敏)少數(shù)局部觸及韌或硬性腫塊脊椎轉(zhuǎn)移瘤84脊椎轉(zhuǎn)移瘤MR特點好發(fā)于胸腰椎,其次為頸椎和骶骨多脊椎發(fā)病(103例中,多發(fā)101例,單發(fā)2例)多累及椎體后部,常侵犯相鄰椎弓根(3/4)椎體靜脈自后方出椎體椎體靜脈與Bason椎靜脈叢廣泛吻合Bason椎靜脈叢血流緩慢,缺乏靜脈瓣,與胸腹腔靜脈廣泛吻合靜脈逆行轉(zhuǎn)移成為常見途徑脊椎轉(zhuǎn)移瘤85脊椎轉(zhuǎn)移瘤MR特點1/4僅累及椎體極少數(shù)僅累及附件椎體內(nèi)病灶單個或多個圓形、卵圓形或不規(guī)則形,邊界較清晰或略模糊可占據(jù)椎體大部或全部脊椎轉(zhuǎn)移瘤86脊椎轉(zhuǎn)移瘤MR特點椎體內(nèi)病灶少數(shù)可伴椎體(壓縮或未壓縮)后緣局限性膨隆椎體壓縮骨折大部信號異?；蛉啃盘柈惓Ｗ刁w前后徑增加脊椎轉(zhuǎn)移瘤87脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件88脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件89脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件90脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件91脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件92脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件93脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件94脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件95脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件96脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件97脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件98脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件99脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件100脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件101脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件102脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件103脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件104脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件105脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件106脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件107脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件108脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件109脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件110脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件111脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件112脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件113脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件114脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件115脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件116脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件117脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件118脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件119脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件120脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件121脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件122脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件123脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件124脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件125脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件126脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件127脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件128脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件129脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件130脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件131脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件132脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件133脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件134脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件135脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件136脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件137脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件138脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件139脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件140脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件141脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件142脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件143脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件144脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件145脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件146脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件147脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件148脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件149脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件150脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件151脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件152脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件153脊柱轉(zhuǎn)移瘤診斷和鑒別診斷課件154