脊柱LCH影像表现分析及鉴别诊断
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摘要
目的探讨脊柱朗格汉斯组织细胞增生症(LCH)的CT和MRI影像表现,以提高对该病影像诊断准确率。方法回顾性分析75例临床病理确诊为LCH患者的临床和影像资料,分析其特征性的影像表现。结果 75例患者中男47例,女28例;18岁及以下50例,18岁以上25例,平均年龄15.9岁,中位年龄10岁。75例中62例为单灶性,13例为多灶性;受累脊柱共117处,其中颈椎65处,胸椎36处,腰椎15处,骶椎1处;受累脊柱呈"地图样"43处(36.8%)、"虫蚀样"44处(37.6%)或穿透样骨质破坏9处(8%);21处(17.9%)骨破坏周围可见硬化边;T_1WI呈等信号28例、低信号19例;T_2WI呈等信号22例、低信号8例、高信号16例或混杂信号1例;49处伴椎旁软组织肿块,32处伴椎旁软组织肿胀。临床随访64例患者,随诊0.5～11年,56例无明显症状,7例有遗留症状,1例复发。结论脊柱LCH青少年多见;单节段累及多见;颈椎相对多见,骨质破坏边界相对清晰,"地图样"和"虫蚀样"骨破坏多见;硬化边不少见;MRI信号相对均匀;椎旁软组织肿块不少见;预后相对良好。
Objective To explore the CT and MRI appearances of Langerhans cell histiocytosis(LCH)in the spine,so as to improve the understanding of LCH and improve accurate diagnosis. Methods Seventy-five cases of LCHs of the spine confirmed by pathological examination were retrospectively analyzed and characteristic imaging appearances were summarized. The relationship between clinical and imaging appearances was compared. Results It was more commonly seen in male than female(47:28) patients. Fifty cases were younger than 18 years old and 25 patient were older than 18,accounting for 66.7% and 33.3%, respectively.Average age was 15.9 years old and the median age was 10 years old. Sixty-two cases were involved in single spinal region and thirteen cases were involved in multiple spinal regions in seventy-five cases and the total sum of lesions was 117. Sixty-five lesions were located in the cervical spine(55.6%),thirty-six lesions were in thoracic spine(30.8%),fifteen lesions were in the lumbar(12.8%)spine. Twenty-five cases showed expansile bone destruction(21.4%); The type of bone destruction was diverse including geographic(36.8%),moth-eaten(37.6%) and permeative bone destruction(8%). The sclerotic margin was visible in 21 cases(17.9%).Twenty-eight tumors showed iso-intensity and nineteen showed low signal intensity on T_1WI; Twenty-two showed iso-intensity,8 cases showed low signal intensity,16 cases showed high signal and 1 displayed heterogeneous signal intensity on T_2WI. Fourty-nine lesions showed a paraspinal mass accounting for 41.9%,32 lesions with swelling of paraspinal soft tissues accounting for 27.4%; patients were clinically followed up from 0.5 to 11 years,56 cases have no obvious symptoms,7 cases with residual symptoms,1 case of recurrence. Conclusion LCH was commonly seen in children. Most of them were unifocal lesions and multiple segment involvement was rare. Cervical spine was the most commonly involved and the main type bone destruction was the geographic and moth-eaten like and the sclerotic rim was not rare. MRI signal was commonly seen as a relatively homogeneous paraspinal mass. The clinical outcomes were comparatively good.
Objective To explore the CT and MRI appearances of Langerhans cell histiocytosis(LCH)in the spine,so as to improve the understanding of LCH and improve accurate diagnosis. Methods Seventy-five cases of LCHs of the spine confirmed by pathological examination were retrospectively analyzed and characteristic imaging appearances were summarized. The relationship between clinical and imaging appearances was compared. Results It was more commonly seen in male than female(47:28) patients. Fifty cases were younger than 18 years old and 25 patient were older than 18,accounting for 66.7% and 33.3%, respectively.Average age was 15.9 years old and the median age was 10 years old. Sixty-two cases were involved in single spinal region and thirteen cases were involved in multiple spinal regions in seventy-five cases and the total sum of lesions was 117. Sixty-five lesions were located in the cervical spine(55.6%),thirty-six lesions were in thoracic spine(30.8%),fifteen lesions were in the lumbar(12.8%)spine. Twenty-five cases showed expansile bone destruction(21.4%); The type of bone destruction was diverse including geographic(36.8%),moth-eaten(37.6%) and permeative bone destruction(8%). The sclerotic margin was visible in 21 cases(17.9%).Twenty-eight tumors showed iso-intensity and nineteen showed low signal intensity on T_1WI; Twenty-two showed iso-intensity,8 cases showed low signal intensity,16 cases showed high signal and 1 displayed heterogeneous signal intensity on T_2WI. Fourty-nine lesions showed a paraspinal mass accounting for 41.9%,32 lesions with swelling of paraspinal soft tissues accounting for 27.4%; patients were clinically followed up from 0.5 to 11 years,56 cases have no obvious symptoms,7 cases with residual symptoms,1 case of recurrence. Conclusion LCH was commonly seen in children. Most of them were unifocal lesions and multiple segment involvement was rare. Cervical spine was the most commonly involved and the main type bone destruction was the geographic and moth-eaten like and the sclerotic rim was not rare. MRI signal was commonly seen as a relatively homogeneous paraspinal mass. The clinical outcomes were comparatively good.
引文
1 Zaveri J,La Q,Yarmish G,et al.More than Just Langerhans Cell Histiocytosis:A Radiologic Review of Histiocytic Disorders[J].Radiographics,2014,34:2008-2024.
2 Stull MA,Kransdorf MJ,Devaney KO.Langerhans cell histiocytosis of bone[J].Radiographics,1992,12:801-823.
3 Bertram C,Madert J,Eggers C.Eosinophilic granuloma of the cervical spine[J].Spine,2002,27:1408-1413.
4方三高,周晓军.解读新版WHO(2013)骨肿瘤分类[J].临床与实验病理学杂,2014,30:119-122.
5 Islinger RB,Kuklo TR,Owens BD,et al.Langerhans'cell histiocytosis in patients older than 21 years[J].Clin Orthop Relat Res,2000,379:231-235.
6 Jiang L,Liu XG,Zhong WQ,et al.Langerhans cell histiocytosis with multiple spinal involvement[J].Eur Spine J,2011,20:1961-1969.
7 Yeom JS,Lee CK,Shin HY,et al.Langerhans'cell histiocytosis of the spine.Analysis of twenty three cases[J].Spine,1999,24:1740-1749.
8刘晓光,钟沃权,刘忠军,等.颈椎朗格罕斯细胞组织细胞增生症的诊断和治疗[J].中国脊柱脊髓杂志,2009,19:431-436.
9 Herman TE,Siegel MJ.Langerhans cell histiocytosis:radiographic images in pediatrics[J].Clin Pediatr(Phila),2009,48:228-231.
10 Guobin H,Lingjing G,Xianglian D,et al.Clinical,pathological,and imaging characteristics of primitive neuroectodermal tumors of the spine[J].Diagn Interv Radiol,2014,20:168-171.
11 Momjian R,George M.Atypical Imaging Features of Tuberculous Spondylitis:Case Report with Literature Review[J].J Radiol Case Rep,2014,8:1-14.
12 Mac Vicar D.Imaging of the spine in patients with malignancy[J].Cancer Imaging,2006,6:S22-S26.
13 Chan MS,Wong YC,Yuen MK,et al.Spinal aneurysmal bone cyst causing acute cord compression without vertebral collapse:CT and MRI findings[J].Pediatr Radiol,2002,32:601-604.
2 Stull MA,Kransdorf MJ,Devaney KO.Langerhans cell histiocytosis of bone[J].Radiographics,1992,12:801-823.
3 Bertram C,Madert J,Eggers C.Eosinophilic granuloma of the cervical spine[J].Spine,2002,27:1408-1413.
4方三高,周晓军.解读新版WHO(2013)骨肿瘤分类[J].临床与实验病理学杂,2014,30:119-122.
5 Islinger RB,Kuklo TR,Owens BD,et al.Langerhans'cell histiocytosis in patients older than 21 years[J].Clin Orthop Relat Res,2000,379:231-235.
6 Jiang L,Liu XG,Zhong WQ,et al.Langerhans cell histiocytosis with multiple spinal involvement[J].Eur Spine J,2011,20:1961-1969.
7 Yeom JS,Lee CK,Shin HY,et al.Langerhans'cell histiocytosis of the spine.Analysis of twenty three cases[J].Spine,1999,24:1740-1749.
8刘晓光,钟沃权,刘忠军,等.颈椎朗格罕斯细胞组织细胞增生症的诊断和治疗[J].中国脊柱脊髓杂志,2009,19:431-436.
9 Herman TE,Siegel MJ.Langerhans cell histiocytosis:radiographic images in pediatrics[J].Clin Pediatr(Phila),2009,48:228-231.
10 Guobin H,Lingjing G,Xianglian D,et al.Clinical,pathological,and imaging characteristics of primitive neuroectodermal tumors of the spine[J].Diagn Interv Radiol,2014,20:168-171.
11 Momjian R,George M.Atypical Imaging Features of Tuberculous Spondylitis:Case Report with Literature Review[J].J Radiol Case Rep,2014,8:1-14.
12 Mac Vicar D.Imaging of the spine in patients with malignancy[J].Cancer Imaging,2006,6:S22-S26.
13 Chan MS,Wong YC,Yuen MK,et al.Spinal aneurysmal bone cyst causing acute cord compression without vertebral collapse:CT and MRI findings[J].Pediatr Radiol,2002,32:601-604.