脊柱上皮样血管内皮瘤的CT及MRI表现(附6例报道并文献复习)
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摘要
目的:总结脊柱原发性上皮样血管内皮瘤(EHE)的CT和MRI表现并复习文献,以提高该病的影像学认识。方法:回顾性分析2011年3月-2015年12月间经病理证实的6例脊柱EHE患者的临床及影像学资料。6例均以脊柱区疼痛为主要症状,其中3例伴周围神经症状。4例行CT检查,5例行MRI平扫及增强扫描。影像学观察内容包括病灶的部位、骨质改变、密度/信号特点、强化特征及周围组织侵犯。结果:6例骨EHE中,发生于椎体5例,附件1例。病灶多呈皂泡状(2例)或蜂窝状(2例)溶骨性骨质破坏,3例伴硬化边,1例伴椎体压缩性骨折。CT平扫呈稍低密度,且密度不均,内伴小点状/斑点状高密度影。T_1WI上呈低信号,T_2WI上呈高信号,信号欠均匀。CT/MRI增强扫描病灶呈中等/明显强化,密度/信号不均。椎间盘均未受累,1例伴脊膜尾征。结论:脊柱EHE多表现为膨胀性溶骨性骨质破坏,呈皂泡状或蜂窝状;伴或不伴硬化边;可伴脊膜尾征;骨膜反应、累及椎间盘少见。
Objective:To summarize and study the CT and MRI manifestations of epithelioid hemangioendothelioma(EHE)and review the literature,in order to improve the understanding of its imaging.Methods:Clinical data of 6 patients with EHE confirmed by pathology from December 2015 to March 2011 were analyzed retrospectively.Clinical symptoms of 6 cases were mainly spinal pain,including 3 cases accompanied with peripheral nerve symptoms.Four cases underwent plain and contrastenhanced CT scan,while 5 cases underwent plain and contrast-enhanced MRI scan.Image observation included the location of the lesion,bone changes,morphology,density/signal characteristics and enhanced features.Results:Five cases were located in the vertebral body and 1 case was located in the accessory of vertebra.Soap bubble appearance was seen in 2 cases,honeycomb osteolytic appearence in 2 cases,sclerotic margin in 3 cases,and accompanied vertebral compression fracture in 1 case.CT showed slightly inhomogeneous low density,with punctate high density foci.MRI showed inhomogeneous low signal on T1 WI and high signal on T2 WI.Contrast-enhanced CT/MRI demonstrated moderate to intensive inhomogeneous enhancement of the lesions.The discs were normal.One case presented dural tail sign.Conclusion:The imaging features of spinal EHE include:expansive osteolytic bone destruction,soap bubble or honeycomb transparent aeras,with or without marginal sclerosis,dural tail sign in case of epidural location,are rare periosteal reaction and intervertebral disc involvement.
Objective:To summarize and study the CT and MRI manifestations of epithelioid hemangioendothelioma(EHE)and review the literature,in order to improve the understanding of its imaging.Methods:Clinical data of 6 patients with EHE confirmed by pathology from December 2015 to March 2011 were analyzed retrospectively.Clinical symptoms of 6 cases were mainly spinal pain,including 3 cases accompanied with peripheral nerve symptoms.Four cases underwent plain and contrastenhanced CT scan,while 5 cases underwent plain and contrast-enhanced MRI scan.Image observation included the location of the lesion,bone changes,morphology,density/signal characteristics and enhanced features.Results:Five cases were located in the vertebral body and 1 case was located in the accessory of vertebra.Soap bubble appearance was seen in 2 cases,honeycomb osteolytic appearence in 2 cases,sclerotic margin in 3 cases,and accompanied vertebral compression fracture in 1 case.CT showed slightly inhomogeneous low density,with punctate high density foci.MRI showed inhomogeneous low signal on T1 WI and high signal on T2 WI.Contrast-enhanced CT/MRI demonstrated moderate to intensive inhomogeneous enhancement of the lesions.The discs were normal.One case presented dural tail sign.Conclusion:The imaging features of spinal EHE include:expansive osteolytic bone destruction,soap bubble or honeycomb transparent aeras,with or without marginal sclerosis,dural tail sign in case of epidural location,are rare periosteal reaction and intervertebral disc involvement.
引文
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[13]马新荣,夏兆云,徐有坤,等.胸椎上皮样血管内皮瘤1例报告并文献复习[J].中国临床医学影像杂志,2012,23(7):531-532.
[14]Hart J,Mandavilli S.Epithelioid angiosarcoma:a brief diagnostic review and differential diagnosis[J].Arch Pathol Lab Med,2011,135(2):268-272.
[15]Mistry AM,Gorden DL,Busler JF,et al.Dignostic and therapeutic challenges in hepatic epithelioid hemangioendothelioma[J].J Gastrointest Cancer,2012,43(4):521-525.
[16]Aquilina K,Lim C,Kamel MH,et al.Epithelioid hemangioendothelioma of spine:report of two cases[J].J Neurosurg Spine,2005,3(5):393-399.
[2]Aflatoon K,Staals E,Bertoni F,et al.Hemangioendothelioma of the spine[J].Clin Orthop Relat Res,2004,418(1):191-197.
[3]回允中.诊断外科病理学(上卷)[M].北京:北京大学医学出版社,2003:178-179.
[4]程虹.软组织与骨肿瘤学和遗传学[M].北京:北京人民卫生出版社,2006:199-202.
[5]张立华,袁慧书.脊柱恶性血管源性肿瘤的影像学表现及鉴别诊断[J].放射学实践,2015,30(4):373-375.
[6]Chireac LR,Rice DC,Raymond AK.Epithelioiod hemangioendothelioma in a patient with unusual involvement of the rib and intercostals lymph nodes[J].J Thorac Cadiovasc Surg,2006,132(6):1488-1489.
[7]Suster S,Moran CA,Koss MN.Epithelioid hemangioendothelioma of the anterior mediastinum.Clinicopathologic,immunohistochemical,and ultrastructural analysis of 12 cases[J].Am J Surg Pathol,1994,18(9):871-881.
[8]Weissferdt A,Moran CA.Epithelioid hemangioendothelioma of the bone:a review and update[J].Adv Anat Pathol,2014,21(4):254-259.
[9]李海,王聪,朱岩,等.上皮样血管内皮瘤13例临床病理分析[J].中华病理学杂志,2015,44(6):386-389.
[10]段承祥,王晨光,李健丁.骨肿瘤影像学[M].北京:科学出版社,2004:387-389.
[11]郭启勇.实用放射学[M].北京:人民卫生出版社,2007:1184-1185.
[12]贾宁阳,王晨光.脊柱影像诊断学[M].北京:人民军医出版社,2007:187-188.
[13]马新荣,夏兆云,徐有坤,等.胸椎上皮样血管内皮瘤1例报告并文献复习[J].中国临床医学影像杂志,2012,23(7):531-532.
[14]Hart J,Mandavilli S.Epithelioid angiosarcoma:a brief diagnostic review and differential diagnosis[J].Arch Pathol Lab Med,2011,135(2):268-272.
[15]Mistry AM,Gorden DL,Busler JF,et al.Dignostic and therapeutic challenges in hepatic epithelioid hemangioendothelioma[J].J Gastrointest Cancer,2012,43(4):521-525.
[16]Aquilina K,Lim C,Kamel MH,et al.Epithelioid hemangioendothelioma of spine:report of two cases[J].J Neurosurg Spine,2005,3(5):393-399.