【正文】 nd chest tube construct filled with PMMA, supplemented by an anterior cervical plate. Left: Preoperative T2weighted magic resonance image, sagittal view, revealing VB collapse at C4. Right: Postoperative cervical xray film, lateral view. Preoperative plain xray film showing marked destruction of the C3 VB and associated kyphotic eformity. Postoperative xray film showing placement of the TPS device into the C3 corpectomy defect, restoring anterior column height. Illustrations of the TPS device. The apparatus is expandable 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 C3. A B C 骨髓瘤 Myeloma 骨髓瘤 臨床病理 ? 骨髓瘤，又稱漿細(xì)胞瘤。起源于骨髓網(wǎng)織細(xì)胞的惡性腫瘤，為圓而脆軟的實質(zhì)新生物 ? 椎體為其好發(fā)部位，絕大多數(shù)為多發(fā)；單發(fā)少見，且約 1/3可轉(zhuǎn)變?yōu)槎喟l(fā)。晚期可廣泛轉(zhuǎn)移。 ? 老幼均可發(fā)病， 40歲以上常見，男 :女＝ 2:1 ? 表現(xiàn)為骨骼疼痛，軟組織腫塊，病理性骨折 ? 化學(xué)治療對多發(fā)性骨髓瘤具有一定療效；嚴(yán)重貧血者可輸血；截癱者施行椎板切除術(shù)；病理骨折者施用適當(dāng)?shù)耐夤潭ǎ惶弁磭?yán)重者可施行放射線治療 骨髓瘤 影像表現(xiàn) ? X線 ? 廣泛性骨質(zhì)疏松：脊柱有壓縮骨折。多發(fā)性骨質(zhì)破壞：穿鑿狀、鼠咬狀骨質(zhì)破壞，邊緣清楚，無硬化邊和骨膜反應(yīng) ? 骨質(zhì)硬化：少見，又稱硬化型骨髓瘤。表現(xiàn)為單純硬化和 /破壞與硬化并存。破壞區(qū)周圍有硬化緣，病變周圍有放射狀骨針及彌漫性多發(fā)性硬化。骨髓瘤治療后也可出現(xiàn)硬化 ? 軟組織腫塊：位于破壞區(qū)周圍，很少跨越椎間盤水平至鄰近椎旁 ? 平片約 10%正常表現(xiàn) 骨髓瘤 影像表現(xiàn) ? CT ? 較 X線平片更能早期顯示骨質(zhì)細(xì)微破壞和骨質(zhì)疏松 ? 典型表現(xiàn)為松質(zhì)骨內(nèi)呈彌漫性分布、邊緣清楚的溶骨性破壞區(qū) ? 常見軟組織腫塊 ? 脊柱常病理性骨折，并硬膜外侵犯 ? MRI ? 對檢出病變、確定病變范圍非常敏感 ? T1WI上，骨破壞區(qū)或骨髓浸潤區(qū)呈低信號。 “椒鹽狀”為特征性表現(xiàn) ? T2WI上呈高信號 ? STIR序列病變高信號較 T2WI更明顯 Left: Anteroposterior radiograph revealing a highly destructive lytic lesion involving both the left iliac wing and left sacrum. Right: Axial CT scan confirming involvement of both of these bones, as well as a moderatesized softtissue mass. Plasmacytomas may be very large and elicit no osseous reaction, as in this case. This case also demonstrates the propensity of aggressive lesions to cross the sacroiliac joint. 61yearold man with multiple myeloma. 多發(fā)骨髓瘤 Lytic expansile mass of C5. Transverse CT image at level of C5 shows expansile softtissue mass along right side of C5 vertebral body, with associated bone destruction. 骨髓瘤 Comparative images from sagittal reformatted CT data set (left) and sagittal STIR MRI(right) of thoracic spine show multiple pression fractures of thoracic vertebral bodies, with severe thoracic kyphosis and marked osteolysis of the T1 vertebral body(arrow). Multiple pression fractures on CT and MR MR CT 骨溶解 Fig. Multiple plasmacytomas with cord pression. a Sagittal T1WI (left) andbSTIR (right) MRI of thoracic spine show scattered focal lesions involving vertebral bodies and posterior elements of thoracic spine. Bothc transverse and sagittal (a, left) MRI show cord pression by a focal expansile mass (arrow) at the T10 spinous process. a b c 多發(fā)漿細(xì)胞瘤 This lateral postoperative plain radiograph was obtained after vertebroplasty was performed to treat fractures of T11, T12, and L1, which produced dramatic symptomatic relief (minimal cement leak into disc space at L1, which was asymptomatic). 59yr M multiple myeloma 多發(fā)骨髓瘤 軟骨肉瘤 Chondrosara 軟骨肉瘤 臨床病理 ? 主要成分為腫瘤性軟骨細(xì)胞鈣化軟骨化骨，成不規(guī)則圓形或葫蘆狀腫塊，腫瘤有特征性的軟骨鈣化 ? 組織學(xué)分三級， Ⅰ 級為低度惡性， Ⅲ 級為高度惡性， Ⅱ 級介于二者之間 ? 多見于男性，男女之比約為 1:。平均發(fā)病年齡 45歲，原發(fā)發(fā)病年齡較發(fā)低 ? 脊柱作為腫瘤的原發(fā)部位約占 3%12%，胸椎最常見；病變起于椎體 15%，后柱 40%，同時受累 45% ? 主要癥狀是疼痛和腫脹，患部運動功能受限 ? 治療以早期徹底去除腫瘤為主，五年治愈率約 20～ 40% 軟骨肉瘤 影像表現(xiàn) ?X線 ?溶骨性破壞，邊界多不清楚，鄰近骨皮質(zhì)可不同程度的膨脹變薄，或破壞后形成軟組織腫塊 ?骨破壞區(qū)和軟組織塊內(nèi)見數(shù)量不等、分布不均、疏密不一的鈣化影 ?環(huán)形鈣化具有定性價值 軟骨肉瘤 影像表現(xiàn) ? CT ? 可見骨破壞區(qū)、軟組織腫塊和鈣化骨化影 ? 能顯示平片不能發(fā)現(xiàn)的鈣化灶。典型鈣化為點狀、環(huán)狀和半環(huán)狀 ? 非鈣化部分可壞死、囊變 ? MRI ? T1WI上為等或低信號，惡性度高的信號強度更低；T2WI上很高信號，惡性度高的信號強度不均勻 ? 骨鈣化和骨化均呈低信號 Chest radiograph shows mild scoliosis and a paraspinal mass (arrow). Lateral radiograph (not shown) did not reveal prominent destruction. CT scan reveals chondroid matrix mineralization in both the osseous lesion (arrowheads) and the associated anterior softtissue mass (arrows). 54yrold F Chondrosara of T 軟骨肉瘤 and T2* gradientecho MR images reveal T6 involvement with marrow replacement (small arrows) and a paravertebral mass (large arrows), which has high signal intensity on d. T6 軟骨肉瘤 Photograph of a sagittally sectioned gross specimen shows the vertebral chondrosara and anterior extension (arrows) and a normal superior vertebral body and disk (*). 軟骨肉瘤 Upper Left and Center: AP and lateral radiographs demonstrating a highly destructive lesion involving S45, with a large softtissue mass, which contains chondroid matrix (arrows). Upper Right: Sagittal T1WI revealing a tremendous low signal softtissue mass extending well into the buttocks (arrows). Lower Left and Right: Axial T2WI demonstrating that the mass replaces the lower sacrum and extends out into both buttocks. The very high signal intensity and lobulated nature of chondroid lesions can be depicted particularly well (lower right) 29yrold F Chondrosara of S 軟骨肉瘤 骨肉瘤 Osteosar 骨肉瘤 臨床病理 ? 主要組織成分為腫瘤性成骨細(xì)胞、腫瘤性骨樣組織和腫瘤骨 ? 椎體很少見，占骨肉瘤的 %，占脊柱原發(fā)惡性腫瘤的 5%，腰骶椎最多見，多數(shù)病例發(fā)生于椎體。 ? 患者多為老年，平均年齡 40歲，男性多見，男女之比約為 2： 1 ? 疼痛和腫脹為常見的臨床癥狀， 70%80%有神經(jīng)癥狀 ? 治療以早期徹底去除腫瘤為主，并輔助放化療 骨肉瘤 影像表現(xiàn) ? X線 ? 骨質(zhì)破壞 ? 腫瘤軟骨鈣化 ? 軟組織腫塊 ? 骨膜增生，骨膜三角 ? 可分三型 ? 硬化型 ? 溶骨型 ? 混合型 ? 對多數(shù)骨肉瘤， X線平片基本可以做出珍， MRI能了解腫塊浸犯的范圍， CT對細(xì)小的骨化和鈣化敏感 骨肉瘤 影像表現(xiàn) ? CT ? 骨破壞以溶骨為主，松質(zhì)骨呈斑片狀 缺損和骨皮質(zhì)的浸蝕 ? 骨質(zhì)增生表現(xiàn)為松質(zhì)骨內(nèi)不規(guī)則斑片高密度和骨皮質(zhì)增厚 ? 軟組織腫塊 ? 增強掃描，實質(zhì)部分要明顯強化 ? MRI ? 骨質(zhì)破壞 。骨膜反應(yīng) 。瘤骨 ? 瘤軟骨鈣化在 T2WI上顯示最好，多在 T1WI上為不均勻的低信號， T2WI上為不均勻的高信號 ? 不規(guī)則腫塊；多平面成像可顯示腫瘤與周圍結(jié)構(gòu)的關(guān)系及周圍侵犯 Lateral radiograph shows classic changes of Paget disease with a picture frame appearance. CT scan reveals destruction of the T12 spinous process (white arrows) with small foci of osteoid matrix (black arrow