白血病浸润硬脊膜并侵犯椎间孔的MRI表现分析
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摘要
目的探讨白血病髓外浸润硬脊膜并侵犯椎间孔的MRI表现和鉴别诊断。方法回顾性分析经临床及病理证实的6例白血病侵犯椎间孔患者的MRI表现和临床资料;所有病灶行脊椎MRI扫描,其中5例行治疗前MRI平扫和增强扫描,1例行治疗前MRI平扫。结果 1例表现为颈椎旁、颈胸椎交界区硬膜下、硬膜外软组织肿块,多个右侧椎间孔肿块; 4例表现为胸段硬膜外软组织肿块并侵犯单侧或双侧椎间孔,其中1例为右侧胸壁白血病浸润并通过椎间孔与椎管内硬膜外病灶沟通; 1例为腰骶椎交界区硬膜外肿块并沿神经根侵及双侧椎间孔,硬膜囊被大部分包绕并受压变窄。4例病灶MRI平扫呈等或稍长T_1、等或稍长T_2信号,增强扫描呈均匀中度-显著强化; 2例呈长T_1不均匀长T_2信号,增强扫描侵犯颈胸椎交界区病灶右侧椎间孔区病灶呈周边性强化,胸椎硬膜外病灶呈不均匀强化。结论白血病髓外浸润侵及椎管时胸段最易受累,最常见类型为膜外浸润,并常沿神经根向椎间孔侵犯。
Objective To evaluate the MRI appearances of Leukemia with dura and intervertebral foramina infiltration,as well as the MRI diagnosis and differential diagnosis. Methods MRI findings and clinical data of 6 cases of clinicallyproven or pathologically-confirmed Leukemia which invaded intervertebral foramina were retrospective analysed. All cases underwent MRI scans of the spine. 5 patients with both pre-contrast and post-contrast MRI scan,1 patient only accepted precontrast MRI examination before local treatment. Results 1 case located at cervicothoracic spine showed an irregular paravertebral tumor,as well as both extradural and subdural masses of right paraspinal region and some right intraforaminal tumors. 4 cases showed extradural masses of thoracic spinal as well as unilateral or bilateral intervertebral foramina involvement. 1 case of right chest wall leukemia infiltration communicates with the epidural lesions through the right intervertebral foramen. 1 case appeared as lumbosacral epidural tumor involved bilateral intervertebral foramina along the nerve roots,and dural sac was mostly wrapped and narrowed. 4 lesions presented almost iso-intensity or slight hypo-intensity to soft tissue on T1 WI and iso-intensity or slight hyperintensity on T_2 WI,and after gadolinium injection,they all enhanced uniformly. Other2 cases showed slight hypointensity on T1 WI and heterogeneous hyperintensity on T_2 WI,and inhomogeneous enhancement.Conclusion The thoracic spinal canal is the most vulnerable spinal canal of Leukemia extramedullary infiltration,and in which epidural infiltration is the most common type,furthermore,epidural lesions often involve intervertebral foramina along the nerve roots.
Objective To evaluate the MRI appearances of Leukemia with dura and intervertebral foramina infiltration,as well as the MRI diagnosis and differential diagnosis. Methods MRI findings and clinical data of 6 cases of clinicallyproven or pathologically-confirmed Leukemia which invaded intervertebral foramina were retrospective analysed. All cases underwent MRI scans of the spine. 5 patients with both pre-contrast and post-contrast MRI scan,1 patient only accepted precontrast MRI examination before local treatment. Results 1 case located at cervicothoracic spine showed an irregular paravertebral tumor,as well as both extradural and subdural masses of right paraspinal region and some right intraforaminal tumors. 4 cases showed extradural masses of thoracic spinal as well as unilateral or bilateral intervertebral foramina involvement. 1 case of right chest wall leukemia infiltration communicates with the epidural lesions through the right intervertebral foramen. 1 case appeared as lumbosacral epidural tumor involved bilateral intervertebral foramina along the nerve roots,and dural sac was mostly wrapped and narrowed. 4 lesions presented almost iso-intensity or slight hypo-intensity to soft tissue on T1 WI and iso-intensity or slight hyperintensity on T_2 WI,and after gadolinium injection,they all enhanced uniformly. Other2 cases showed slight hypointensity on T1 WI and heterogeneous hyperintensity on T_2 WI,and inhomogeneous enhancement.Conclusion The thoracic spinal canal is the most vulnerable spinal canal of Leukemia extramedullary infiltration,and in which epidural infiltration is the most common type,furthermore,epidural lesions often involve intervertebral foramina along the nerve roots.
引文
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3李吉满,刘卫平,张明虎,等.髓系肉瘤的临床病理特征及免疫组织化学在其鉴别诊断中的作用[J].中华病理学杂志,2006,35:606-611.
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10李丹,赵天平,程敬亮,等.白血病浸润硬脊膜并形成硬膜外肿块的MRI表现(2例报告并文献复习)[J].临床放射学杂志,2015,34:308-310.
11侯刚,陈玉林,夏钰弘,等.少见椎管内硬膜外占位性病变的MRI表现[J].影像诊断与介入放射学,2011,20:403-406.
12 Krishnan P,Bhattacharya C,Roy S,et al.Granulocytic sarcoma of the dorsal spine in an aleukemic patient[J].J Cancer Res Ther,2015,11:1009-1011.
13 Seo JY,Ha KY,Kim MU,et al.Spinal cord compression by B-cell lymphoma,unclassifiable,with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma in a patient seropositive for human immunodeficiency virus:a case report[J].J Med Case Rep,2014,8:324.
14 Sachdev RK,Sen A,Pathak A,et al.Primary extradural non-hodgkin's lymphoma[J].Indian J Nucl Med,2012,27:185-186.
15鱼搏浪.中枢神经系统CT和MRI鉴别诊断[M].西安:陕西科学技术出版社,2005,663-665.
16 Thakkar SD,Feigen U,Mautner VF.Spinal tumours in neurofibromatosis type 1:an MRI study of frequency,multiplicity and variety[J].Neuroradiology,1999,41:625-629.
17张立华,袁慧书.脊膜瘤少见征象分析[J].实用放射学杂志,2012,28:1175-1178.
18陈宇,徐坚民,李莹,等.原发性胸椎原始神经外胚层肿瘤的动态增强MRI表现[J].中华放射学杂志,2004,38:860-863.
2 Lekovic GP,Schwartz MS,Go JL.Multifocal granulocytic sarcoma of the spine mimicking neurofibromatosis Type 2:case report[J].JNeurosurg Spine,2016,25:523-527.
3李吉满,刘卫平,张明虎,等.髓系肉瘤的临床病理特征及免疫组织化学在其鉴别诊断中的作用[J].中华病理学杂志,2006,35:606-611.
4 Young Kim J,Ah Im S,Hyun Lee J,et al.Extramedullary Relapse of Acute Myeloid and Lymphoid Leukemia in Children:A Retrospective Analysis[J].Iran J Pediatr,2016,26:e1711.
5 Dores GM,Devesa SS,Curtis RE,et al.Acute leukemia incidence and patient survival among children and adults in the United States,2001-2007[J].Blood,2012,119:34-43.
6 Cervantes GM,Cayci Z.Intracranial CNS Manifestations of Myeloid Sarcoma in Patients with Acute Myeloid Leukemia:Review of the Literature and Three Case Reports from the Author's Institution[J].J Clin Med,2015,4:1102-1112.
7 Petursson SR,Boggs DR.Spinal cord involvement in leukemia:a review of the literature and a case of Ph1+acute myeloid leukemia presenting with a conus medullaris syndrome[J].Cancer,1981,47:346-350.
8柏树令.系统解剖学[M].北京:人民卫生出版社,2008,423.
9 Bittencourt H,Teixeira Junior AL,Glória AB,et al.Acute promyelocytic leukemia presenting as an extradural mass[J].Rev Bras Hematol Hemoter,2011,33:478-480.
10李丹,赵天平,程敬亮,等.白血病浸润硬脊膜并形成硬膜外肿块的MRI表现(2例报告并文献复习)[J].临床放射学杂志,2015,34:308-310.
11侯刚,陈玉林,夏钰弘,等.少见椎管内硬膜外占位性病变的MRI表现[J].影像诊断与介入放射学,2011,20:403-406.
12 Krishnan P,Bhattacharya C,Roy S,et al.Granulocytic sarcoma of the dorsal spine in an aleukemic patient[J].J Cancer Res Ther,2015,11:1009-1011.
13 Seo JY,Ha KY,Kim MU,et al.Spinal cord compression by B-cell lymphoma,unclassifiable,with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma in a patient seropositive for human immunodeficiency virus:a case report[J].J Med Case Rep,2014,8:324.
14 Sachdev RK,Sen A,Pathak A,et al.Primary extradural non-hodgkin's lymphoma[J].Indian J Nucl Med,2012,27:185-186.
15鱼搏浪.中枢神经系统CT和MRI鉴别诊断[M].西安:陕西科学技术出版社,2005,663-665.
16 Thakkar SD,Feigen U,Mautner VF.Spinal tumours in neurofibromatosis type 1:an MRI study of frequency,multiplicity and variety[J].Neuroradiology,1999,41:625-629.
17张立华,袁慧书.脊膜瘤少见征象分析[J].实用放射学杂志,2012,28:1175-1178.
18陈宇,徐坚民,李莹,等.原发性胸椎原始神经外胚层肿瘤的动态增强MRI表现[J].中华放射学杂志,2004,38:860-863.