髓外硬膜下血管瘤MRI诊断

MRI Diagnosis of Intradural Extramedullary Hemangioma

摘要: 背景：探讨髓外硬膜下血管瘤的MRI诊断特征。方法：分析、比较5例髓外硬膜下毛细血管瘤和3例髓外硬膜下海绵状血管瘤的MRI与手术病理表现。结果：瘤体位于脊椎胸段4例，腰段2例，颈胸段、腰骶段各1例。瘤体呈结节状，5例边缘光整，3例边缘分叶。MRI-病理对照显示，毛细血管瘤以T1WI等信号、T2WI稍高信号及显著强化为主，镜下为均质的毛细血管样血管结节；海绵状血管瘤以T1WI等信号、T2WI稍高信号混杂极低信号及异质性强化为主，镜下可见出血及血栓。5例可见瘤周血管征，其中海绵状血管瘤中1例，毛细血管瘤中4例。5例检出脊髓水肿，其中海绵状血管瘤2例，毛细血管瘤3例。结论：髓外硬膜下血管瘤MRI表现具有多样性，海绵状血管瘤较毛细血管瘤更易发生出血，瘤周血管征和脊髓水肿是该瘤的特征性MRI征象。

Abstract: Background: To assess the MRI diagnostic features of intradural extramedullary hemangioma. Methods: The MRI findings and surgicopathological observations were analyzed and compared of 5 patients with intradural extramedullary capillary hemangioma and 3 patients with intradural extramedullary cavernous hemangioma. Results: On the tumoral locations in the spine of the 8 pa-tients, the hemangioma was noted in thoracic section in 4 patients, in lumbar section in 2 patients, and in cervicothoracic and lumbosacral sections in 1 patient, respectively. The tumoral mass was presented as nodular figuration, which being smoothly marginated in 5 and lobulatedly demar-cated in 3 masses. MRI-pathology correlation revealed that capillary hemangioma was predomi-nated by iso-intensity on T1-weighted image, slight hyper-intensity on T2-weighted image and marked post-contrast enhancement, and homogeneous nodes composed of capillary-like vessels microscopically; while cavernous hemangioma was displayed primarily as iso-intensity on T1-weighted image, slight hyper-intensity mixed with extreme hypo-intensity on T2-weighted image and heterogenous post-contrast enhancement, and intratumoral hemorrhage and thrombus microscopically. The peri-tumoral vessel sign was identified in 5 patients, involving 1 with cavernous hemangioma and 4 with capillary hemangioma. 5 patients were detected with spinal cord edema, including 2 patients with cavernous hemangioma and 3 with capillary hemangioma. Conclusion: The peri-tumoral vessel sign and spinal cord edema comprise the characteristic MRI signs of intradural extramedullary hemangioma, which possesses versatile MRI findings and a tendency to develop hemorrhage in cavernous hemangioma than in capillary hemangioma.