第172课 病例探析（024）—胸椎血管瘤

上期试题：颅内脊索瘤好发部位为D

A．蝶鞍部

B．桥小脑角区

C．颅前窝

D．颅底枕软骨结合处

E．颈静脉孔区

患者，男，41岁，4个月前无明显诱因出现下半身麻木，未予处理，4个月来症状逐渐加重。

查体：脊柱生理曲度存在，各棘突无压痛。自脐水平向下感觉减退，双下肢活动正常，肌力约IV级，肌张力稍高，双直腿抬高试验（—），双巴氏征（—），双膝腱、跟腱反射未引出，双髋阵挛（—）。相关实验室检查无异常。

X线片示胸9/10椎体内见粗大骨小梁影，呈栅栏状改变，椎体上缘局部骨皮质凹陷。

CT平扫示胸9/10椎体内骨小梁稀疏、粗大，呈网眼状、栅栏样改变，胸9椎体上缘骨皮质不连续，局部骨质凹陷，周围软组织肿胀。

MR示胸9/10椎体上缘凹陷，椎体内骨小梁增粗呈栅栏状，周围见大片状长T1、长T2信号，胸9椎体后缘向椎管内突起，呈长T1、长T2信号，硬脊馍囊及脊髓受压，椎体周围软组织肿胀。

骨血管瘤在组织学上是一种呈瘤样增生的血管组织，掺杂于骨小梁之间，部分骨小梁被压迫吸收，其余部分则反应性增粗，分为海绵型血管瘤和毛细血管瘤。可发生于任何年龄，以中老年多见，好发于脊柱、颅骨、长骨等。根据其所在部位，可发生相应的临床症状。发生于脊柱的血管瘤X线表现为椎体内粗大骨小梁呈栅栏状、网格状排列，无软组织肿块及骨膜反应；CT平扫表现为骨松质呈粗大网眼状、残留骨小梁粗大，周围可见脂肪沉积，矢状位和冠状位重建图像上呈栅栏样改变，CT增强扫描因大量粗大的骨小梁存在，强化表现不明显，延伸到椎旁软组织内的血管瘤可呈明显强化。MRI表现为血管瘤在T1WI像呈稍低、等或稍高信号，T2WI像呈均匀的高信号，MR增强扫描后血管瘤呈明显强化。

Bit of hemangioma is a kind of show on histologic tumor vascular tissue hyperplasia, doping in the trabecular bone, part of the oppression of the trabecular bone absorption, the rest is reactive enlargement, divided into sponge type hemangioma and capillary tumor. Can occur at any age, in middle and old age, good hair in the spine, skull, long bone and so on. According to its location, corresponding clinical symptoms can occur. The X-ray of the hemangioma of the vertebral column was presented as a palisade, grid arrangement, no soft tissue mass and periosteum reaction. CT scan of cancellous bone bulky mesh shaped, residual bone trabecular thick, fat deposits around, sagittal and coronal reconstruction images on a fence sample change, CT enhanced scan for a large number of bulky of trabecular bone, to strengthen the performance is not obvious, extends to the vertebral side of soft tissue hemangioma can show obvious reinforcement. MRI showed that hemangioma was slightly lower in the T1WI image, etc., and the T2WI was like a uniform high signal, and MR enhanced the hemangioma after scanning.

本例应与椎体转移瘤鉴别。椎体转移瘤发病年龄较大，多有恶性肿瘤病史，可见软组织肿块影，常见椎弓根受累，无粗大的骨小梁排列成栅栏状改变。

This example should be identified with a vertebral metastatic tumor. The incidence of vertebral metastasis is much older, and there is a history of malignant tumor, and the shadow of the soft tissue is visible, and the common vertebral arch is tired, and the non-thick bone trabecular is arranged in a palisade change.

本期试题：在下列骨肿瘤疾病中，对于放射治疗敏感的是（多选）？

A．骨肉瘤

B．脊椎血管瘤

C．骨巨细胞瘤

D．尤文肉瘤

E．纤维肉瘤

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