29例脊索瘤的影像学诊断及鉴别诊断(1)
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[摘要] 目的 探讨脊索瘤的影像学表现及鉴别诊断。方法 回顾性分析经手术病理证实的29例脊索瘤的影像学表现及特点。结果 29例脊索瘤中，发生于骶尾部15例(51.7%)，发生于颅底13例(44.8%)，发生于外周1例(3.5%)。平片可见颅底及骶尾椎融骨性骨质破坏；CT可特征性显示斜坡及骶尾椎膨胀性软组织肿块及广泛融骨性骨质破坏；MRI对病变范围的显示优于CT。结论 CT对显示脊索瘤的骨质破坏、残存方面优于MRI，但MRI对脊索瘤的范围、内部结构及周围神经、血管的关系具有较高的敏感性和一定的特征性，有助于确定外科手术方案及对术后的评估。
[关键词] 肿瘤；脊索瘤；磁共振成像；计算机体层摄影
[中图分类号] R814.42 [文献标识码] B[文章编号] 1673-9701(2011)20-103-03
Imaging Diagnosis and Differential Diagnosis of Chordomas
WU Haisheng1CHENG You2
1.Deparment of Radiology，Ganzhou People’s Hospital of Jiangxi Province，Ganzhou 341000，China；2.Deparment of Radiology，Foshan Jun’an Hospital of Guangdong Province，Foshan 528329，China
[Abstract] Objective To investigate the imaging manifestations and differential dignosis of chordoma. Methods The imaging manifestation and characteristic of chordoma in 29 cases proved by surgery and pathology were analyzed retrospectively. Results In this series of29 chordoms，the lesions located at the region of sacrococcygeal region 15 cases(51.7%)，at the skull base in 13 cases(44.8%) and 1 case(3.5%) outside the axial skeleton as an extra-axial chordoma or parachordom. Bone destruction in the areas near skull base and sacrococcygeal region could be found on radiography；On CT，chordom typically appeared as a expansile soft-tissue mass that arises from the clivus and sacrococcygeal region with associated extensive lytic bone destruction；MR imaging was considerably superior to CT in the delineation of lesion extent. Conclusion CT shows bone invasion easier than MRI，but MRI can well display the extent，interior structure of tumors， as well as its relationship with adjacent nerves andvessel，and therefore benefits the decision of surgical project and the postoperative evaluation.
[Key words] Tumor；Chordoma；Magnetic resonance imaging；Computerized tomography
脊索瘤(chordoma)来源于残存或异位的胚胎性脊索组织，是一种原发低度恶性骨肿瘤，好发于骶尾部及颅底蝶枕软骨结合处[1]。笔者回顾性分析经手术及病理证实的29例脊索瘤的影像学表现，以期提高对该病的认识。
1资料与方法
1.1一般资料
收集2007年3月～2010年9月经本院神经外科手术后病理证实的29例脊索瘤患者，其中骶尾部脊索瘤15例，颅底脊索瘤13例，外周软组织脊索瘤1例。
1.2检查方法
29例病例均行MRI检查及增强扫描，20例同时行CT检查，16例摄头颅或腰骶椎正侧位片。所有病例均经手术及病理证实。检查仪器为 MRI：德国西门子1.5T超导8通道MRI；CT：日本东芝超高速螺旋CT；X线：美国GE的DR和德国AGFA的CR ......
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