摘要
目的 研究脊椎转移瘤平片椎弓根征的实质 ,探讨脊椎转移瘤的CT诊断与鉴别诊断的有益征象。方法 分析 48例 6 6个椎骨转移瘤、19例脊椎结核和 11例脊椎骨髓瘤的CT影像和其中 34例转移瘤的平片表现。结果 6 6个椎骨转移瘤中 ,椎体完全破坏的多见双侧椎弓根破坏 (15 /2 8) ,偏侧破坏多见单侧椎弓根破坏 (16 /2 2 ) ,微转移瘤病灶集中在椎体 (5 6 /6 2 )。转移瘤与骨髓瘤的椎弓根破坏率无显著性差异 (χ2 =0 0 3,P >0 5 0 ) ;二者的椎体破坏部位分布无显著性差异 (χ2 =3 5 2 ,P >0 10 ) ,但与结核存在极显著性差异 (χ2 =39 32 ,P <0 0 0 1) ;转移瘤与结核的椎骨内病变分布无显著性差异 ,二者与骨髓瘤有显著性差异。结论 脊椎转移瘤最初侵犯椎体 ,平片椎弓根征是椎体病变向后扩展的结果。椎弓根征对转移瘤与骨髓瘤无鉴别意义 ,椎旁软组织肿块、椎体破坏部位及椎骨内病变分布特征有助于转移瘤和结核、骨髓瘤的鉴别。
Objective To investigate the essence of the vertebral pedicle sign of vertebral metastasis on plain film, and to explore the useful CT signs for the diagnosis and differential diagnosis of this tumor. Methods The CT scans of the spine obtained in 48 patients with vertebral metastases,19 patients with vertebral tuberculosis, and 11 with vertebral myeloma, were analyzed. The CT findings were correlated with the abnormalities seen on plain films in 34 of the 48 patients (66 vertebrae involved) with vertebral metastasis. Results 66 vertebrae were involved in the group of metastasis. Of the 28 vertebrae whose vertebral body were completely destroyed,15 were seen bilateral pedicles destruction;Of the 22 vertebrae with lateral destruction of the body,16 were noticed unilateral pedicle destruction which located posterior to the involved side of the body. Of the 62 micro metastatic foci,56 were scattered in the vertebral body. In the 19 paraspinal soft tissue masses of vertebral tuberculosis,5 were noticed calcifications and 12 with postcontrast rings enhancement. The rates of vertebral pedicle destruction of vertebral metastasis and myeloma were not statistically different (χ 2=0.03, P>0.50). The locations of destruction of vertebral body in vertebral metastasis and myeloma had no statistical difference(χ 2=3.52, P>0 10),but they differed from that in tuberculosis(χ 2=39 32, P<0 001). The distribution of lesions within the vertebrae of metastasis and tuberculosis was similar,but was quite different from myeloma. Conclusion The vertebral metastasis initially occurs in the vertebral body. The vertebral pedicle sign on plain film of vertebral metastasis is the outcome of the posterior invasion of the tumor in the vertebral body,which is of no differential significance for vertebral metastasis and myeloma. Paraspinal soft tissue mass,location of destruction of vertebral body, and the distribution of lesions within the vertebrae may help differentiate vertebral metastasis from vertebral tuberculosis and myeloma.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2000年第8期518-522,共5页
Chinese Journal of Radiology
关键词
脊椎转移瘤
CT
诊断
椎弓根征
脊椎结核
Spine
Neoplasm metastasis
Tomography,X ray computed
Tuberculosis
Multiple myeloma
