飞雪 发表于 2014-12-16 22:41:21

椎管内硬膜外血管脂肪瘤(Spinal Epidural Angiolipoma)MRI病例

14:59 53岁女性,双下肢无力、感觉异常,步态异常。A 53-year-old woman with lower extremity weakness, paresthesia, and gait abnormalities
矢状位T2WI (A) 及T1WI (B) 示椎管内占位,表现为T1WI和T2WI不均匀高信号,病灶位于胸椎管背侧硬膜外间隙。矢状位T1WI脂肪抑制序列(C)病灶呈低信号。横断位T1WI脂肪抑制增强扫描序列 (D)示病灶呈明显不均匀强化。
Sagittal T2WI (A) and sagittal T1WI (B) demonstrate an intraspinal, extradural, heterogeneous, predominantly T1-weighted and T2-weighted hyperintense lesion in the dorsal extradural compartment (ie, posterior epidural) of the thoracic spine, which suppressess on fat-saturated sagittal T1WI (C). Contrast-enhanced fat-suppressed axial T1WI (D) demonstrates avid heterogeneous enhancement of the lesion.

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飞雪 发表于 2014-12-16 22:46:15

14:59 硬膜外血管脂肪瘤Spinal Epidural AngiolipomaSpinal angiolipoma is a rare, benign, and usually non-infiltrating tumor that accounts for approximately 1% of all spinal tumors and 2%–3% of extradural spinal tumors. Spinal angiolipomas contain mature lipomatous elements and proliferating vessels, and these tumors have been suggested as an intermediate entity on a spectrum ranging from angiomas to lipomas.
椎管内血管脂肪瘤是一种罕见的、良性非侵袭性肿瘤,约占全部椎管肿瘤的1%,硬膜外肿瘤的2%-3%。椎管内血管脂肪瘤内包括成熟的脂肪细胞和增生的血管构成,被建议作为介于血管瘤和脂肪瘤之间的一类肿瘤。
There is an infiltrating angiolipoma subtype which is extremely rare. These usually involve the extremities and may extensively infiltrate into the surrounding tissues, such as bones, muscles, nerves, and fibrocollagenous tissues. Spinal infiltrating angiolipomas are usually ventrally located.
浸润性血管脂肪瘤是一种临床非常罕见的亚型,常累及四肢,并广泛浸润周围组织,如骨骼、肌肉、神经、纤维胶原组织。椎管内浸润性血管脂肪瘤常位于椎管内腹侧。
Clinical Presentation:
Patients present with back pain, progressive unstable gait, paraparesis, and paresthesias of the lower limbs.
患者常表现为背痛、渐进性步态不稳、下肢轻瘫、及下肢感觉障碍。
Key Diagnostic Features:
Heterogeneous extradual lesion, predominantly hyperintense on T1WI, with variable (but typically hyperintense) signal intensity on T2WI
椎管内硬膜外不均质肿块,T1WI高信号,T2WI信号复杂(典型表现为高信号)
Fat-saturation sequences are helpful.
脂肪抑制序列有助于诊断
Heterogeneous enhancement is seen following contrast administration.
增强扫描不均匀强化
鉴别诊断(DDx):
Lipomatosis 脂肪过多症
does not enhance after contrast administration
增强扫描无强化
Metastases 转移瘤
does not have fat signal
没有脂肪信号
usually invades bone and soft tissues
常侵犯临近骨骼、软组织
Lymphoma 淋巴瘤
does not have fat signal
没有脂肪信号
homogeneous enhancement
增强扫描均匀强化
bone and soft-tissue infiltration is common
骨骼、软组织受侵较常见
Neurogenic tumor 神经源性肿瘤
usually well circumscribed
通常边界清楚
rarely located solely in the posterior epidural space
很少完全位于硬膜外间隙
Rx:
Surgical resection
手术切除
病例来源:双语学影像AJNR Case of the Week (December 8, 2014)

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