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1、脊柱病變的影像學(xué)診斷山東省醫(yī)學(xué)影像學(xué)研究所李傳亭CT脊柱檢查CT脊柱檢查MRI檢查脊柱的優(yōu)勢(shì)總體優(yōu)勢(shì)：多參數(shù)成像多方位成像，尤其矢狀斷層獨(dú)特優(yōu)勢(shì)：目前唯一能直接顯示脊髓內(nèi)部的影像檢查方法椎間盤(pán)病變椎間盤(pán)及椎體的退變椎間盤(pán)膨出和脫出從脊柱長(zhǎng)軸全面觀察以免漏掉其他病變觀察突出椎間盤(pán)對(duì)脊髓或神經(jīng)根的壓迫程度DEGENERATION椎間盤(pán)變性：SET2GRET2*T1WI椎體終板信號(hào)改變：DEGENERATIONNormalPost-radiotherapyDISC-HERNIATIONDISC-HERNIATIOND
2、ISC-HERNIATIONDISC-HERNIATIONDISC-HERNIATIONDISC-HERNIATION椎管狹窄分型：中心型外圍型先天型后天型頸椎病DISC-HERNIATIONBASALDEPRESSIONSPINALCANALSTENOSISOPLL脊柱創(chuàng)傷觀察脊髓的受傷程度：水腫、腫脹、出血、斷裂、軟化觀察椎體的狀況：有形態(tài)改變的骨折無(wú)明顯形態(tài)改變的小梁骨折觀察椎管的其他改變：增生、狹窄脫位:位置錯(cuò)位3.5cm成角11度TRAUMATRAUMA脊髓震蕩脊髓受壓脊髓挫傷脊髓損傷三型:1挫傷伴出
3、血2水腫3混合TRAUMATRAUMATRAUMA椎管腫瘤髓內(nèi)腫瘤髓外硬膜下腫瘤硬膜外腫瘤髓內(nèi)腫瘤IntramedullarySpinalNeoplasmsEpendymoma(室管膜瘤)Themostcommonintramedullaryspinalneoplasminadults,60%,38.8,maleCervicalcordalonetheupperthoracicregion.MyxopapillaryependymomaDurationofsymptomswas36.5monthsBackorn
4、eckpain(67%),sensorydeficits(52%),motorweakness(46%),ImagingCharacteristicsCTX-ray:scoliosisorcanalwideningwithassociatedvertebralbodyscalloping,pedicleerosion,orlaminarthinningMRI:T1WIiso-orhypointense;T2WIhyperintensethe"capsign,"arimofextremehypointensity
5、(seenatthepolesofthetumoronT2WI.cordedema.3.6vertebralsegments;Cystsareacommon,SyringohydromyeliaWellcontrast-enhanced室管膜瘤髓內(nèi)腫瘤室管膜瘤室管膜瘤Astrocytoma(星形細(xì)胞瘤)One-thirdofallspinalcordgliomas；Male；29years；thoraciccord(67%),cervicalcord(49%)；Involvementoftheentirespi
6、nalcord；rarefilumterminale；rarelyexophytic.Painandsensorydeficits；Motordysfunction.Youngchildren,withamediandurationof5months.PathologicCharacteristicsIll-defineddiffusefusiformenlargement.Tumorcysts(eccentric,smaller,andirregular)andsyrinxesarecommonHyperce
7、llularityandtheabsenceofasurroundingcapsuleEnlarged,irregularlyshaped,hyperchromaticnucleiWHOclassificationGradeI：pilocyticastrocytomas75%GradeII：fibrillarytypeGradeIII：anaplasticastrocytomas25%GradeIV：glioblastomamultiformedistinctlyuncommonGradeIIGradeIVIm
8、agingCharacteristicsCT、X-ray：mildscoliosis,widenedinterpediculardistance,andboneerosionMRI：poorlydefinedmargins；T1WIiso-tohypointense；T2WIhyperintense；sevenvertebralsegments；Cysts；eccentric；some
