-
海绵状血管瘤是一种良性血管畸形,并不是真正的肿瘤。骨海绵状血管瘤好发于脊柱及颅骨,在脊柱中多发生于椎体,约占脊柱血管瘤的5%~12%,占脊柱肿瘤的4%[1-4]。椎体海绵状血管瘤可侵犯周围组织,延伸到硬膜内、外腔,形成椎管内硬膜内、外海绵状血管瘤[5]。MRI通常表现为T1WI低信号或等信号,T2WI高信号或等信号,增强扫描时明显强化[4, 6]。由于海绵状血管瘤血管腔内有血栓的钙化或机化,CT扫描表现为瘤体内点片状钙化灶及增厚的骨小梁,此为海绵状血管瘤特征性指标,对海绵状血管瘤的诊断具有很高的灵敏度。18F-FDG PET显像提示海绵状血管瘤是一种18F-FDG低摄取的良性肿瘤[7]。有研究报道,海绵状血管瘤18F-FDG PET的SUVmax<2.5[8]。
MRI误诊的椎体海绵状血管瘤18F-FDG PET/CT显像一例
18F-FDG PET/CT findings of a thoracic vertebral cavernous hemangioma: a case of MRI misdiagnosis
-
摘要: 笔者报道了一例双下肢乏力4月余,加重伴疼痛、活动受限一周的病例。MRI显示病灶累及胸3椎体、椎体附件和周围组织,并延伸到椎管内硬脊膜,增强后病变明显强化,MRI因病变范围广且增强后明显强化,考虑为恶性肿瘤。而18F-FDG PET低代谢结合CT点状、栅栏状钙化灶和椎体骨质无破坏,考虑为海绵状血管瘤;且术后病理因病灶内见异常血管聚集成丛状,血管腔内有大量红细胞,诊断为海绵状血管瘤。文献复习加深了对椎体海绵状血管瘤的认识,其可累及椎体、椎体附件,甚至延伸到椎管内和(或)周围组织。海绵状血管瘤是一种血管畸形,MRI增强后呈明显强化,但是PET显像则呈低代谢。当MRI显示病变范围广伴明显强化,而椎体无骨质破坏,怀疑恶性肿瘤时,应结合PET/CT对诸如海绵状血管瘤等良性病变进行鉴别诊断。Abstract: We report a 69-year-old female with nearly 4 months of bilateral lower limb weakness and about 1 week of limited activity and pain. MRI of the thoracolumbar spine revealed that the lesion was mainly on the vertebral body and the corresponding intraspinal, epidural, and paravertebral soft tissues. In the Gd-enhanced images, the lesion was highly apparent and was diagnosed as a malignant tumor. However, the punctate bone density was increased upon PET/CT and 18F-FDG uptake was low. Furthermore, PET/CT imaging showed a cavernous hemangioma, and this was confirmed by histological examination of the tumor. The understanding of the cavernous hemangioma was deepened by literature review. A cavernous hemangioma can involve the vertebral body and vertebral appendages, and can even extend into the spinal canal and surrounding tissues. Cavernous hemangioma is a benign vascular malformation. The Gd-enhanced imaging is a valuable enhancement tool. Moreover, PET showed low 18F-FDG uptake. When the MRI lesions are widespread and obvious, malignancy should not be ruled out. Furthermore, PET/CT should be used for the differential diagnosis of benign lesions, such as cavernous hemangioma.
-
Key words:
-
[1] Cha JG, Yoo JH, Kim HK, et al. PET/CT and MRI of intra-osseous haemangioma of the tibia[J/OL]. Br J Radiol, 2012, 85(1012): e94-e98[2017-03-05]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486666/pdf/bjr-85-e094.pdf. DOI: 10.1259/bjr/35251836. [2] Matsumoto Y, Takahashi Y, Haraguchi A, et al. Intraosseous hemangioma arising in the clavicle[J]. Skeletal Radiol, 2014, 43(1):89-93. DOI:10.1007/s00256-013-1715-3. [3] Khalatbari MR, Abbassioun K, Amirjmshidi A. Solitary spinal epidural cavernous angioma:report of nine surgically treated cases and review of the literature[J]. Eur Spine J, 2013, 22(3):542-547. DOI:10.1007/s00586-012-2526-2. [4] Tan S, Kurt A, Okutan O, et al. CT findings of a thoracic vertebral hemangioma presenting with acute neurological symptoms[J].Turk Neurosurg, 2011, 21(1):113-115. [5] Yunoki M, Suzuki K, Uneda A, et al. A case of dumbbell-shaped epidural cavernous angioma in the lumbar spine[J]. Surg Neurol Int, 2015, 6(Suppl 10):S309-312.DOI:10.4103/2152-7806.159378. [6] Ciurea ME, Bondari S, Stoica LE, et al. Role of MRI in the diagnosis and evaluation of cavernous hemangioma of the arm[J]. J Med Life, 2014, 7(1):46-50. [7] Ko SW, Park JG. Cavernous hemangioma of the ilium mimicking aggressive malignant bone tumor with increased activity on 18F-FDG PET/CT[J]. Korean J Radiol, 2013, 14(2):294-298. DOI:10.3348/kjr.2013.14.2.294. [8] Shin JH, Lee HK, Rhim SC, et al. Spinal epidural cavernous hemangioma:MR findings[J]. J Comput Assist Tomogr, 2001, 25(2):257-261. DOI:10.1097/00004728-200103000-00019. [9] 赵鑫福.椎管内硬膜外海绵状血管瘤MRI表现[J].中国实用医药, 2015, 10(3):118-119. DOI:10.14163/j.cnki.11-5547/r.2015.03.080.
Zhao XF. MRI findings of epidural cavernous hemangioma in the spinal canal[J]. China Prac Med, 2015, 10(3):118-119. doi: 10.14163/j.cnki.11-5547/r.2015.03.080[10] Yang L, Liu Z, Su L, et al. Primary bone lymphoplasmacytic lymphoma presenting with spinal cord compression:a case report[J]. Turk J Hematol, 2013, 30(4):409-412. DOI:10.4274/Tjh.2012. 0072. [11] 金民山, 张俊, 姜一逸. 18F-PET/CT在不明原发灶肿瘤中的临床应用价值[J].国际放射医学核医学杂志, 2017, 41(2):94-97. DOI:10.3760/cma.jssn.1673-4114.2017.02.003.
Jin MS, Zhang J, Jiang YY. Clinical value of 18F-FDG PET/CT in cancer of unknown primary[J]. Int J Radiat Med Nucl Med, 2017, 41(2):94-97. doi: 10.3760/cma.jssn.1673-4114.2017.02.003[12] Park HS, Song YJ. Multiple tuberculoma involving the brain and spinal cord in a patient with miliary pulmonary tuberculosis[J]. J Korean Neurosurg Soc, 2008, 44(1):36-39. DOI:10.3340/jkns.2008.44.1.36.