無癥狀性椎體血管瘤的磁共振隨訪研究

周曉航 陳瑩 史凱文 陳梓瑋 何丹云 丁洪偉

【摘要】目的：通過磁共振成像探討無癥狀性椎體血管瘤（vertebral hemangiomas，VH）的轉歸可能，指導臨床對無癥狀性椎體血管瘤的預防與治療。方法：對160例既往通過磁共振診斷為椎體血管瘤患者再次行進行磁共振檢查，根據既往磁共振影像將160例患者分為侵襲性VH115例，非侵襲性VH45例，對所有患者既往的磁共振及復查的磁共振影像矢狀面T1加權、T2加權、脂肪抑制像進行回顧性分析。結果：115例原為侵襲性VH患者中84例復查磁共振后顯示為非侵襲性，31例仍為侵襲性，45例原為非侵襲性VH患者中，復查磁共振后仍為非侵襲性43例，自愈2例。結論：侵襲性VH患者最終向非侵襲性進展（84/115，73.04%），并存在產生癥狀的可能（2/115，1.74%）。非侵襲性VH更趨于穩定，也不產生癥狀（43/45，95.56%），甚至有自愈的可能性（2/45， 4.44%）。這對臨床上椎體血管瘤的疾病動態過程、預防及處理提供重要參考價值。

【關鍵詞】椎體血管瘤;磁共振;侵襲性;無癥狀性

Magnetic resonance follow-up study of asymptomatic vertebral hemangioma

Magnetic resonance follow-up study of asymptomatic vertebral hemangioma

Zhou Xiaohang， Chen Ying， Shi Kaiwen， Chen Ziwei， He Danyun， Ding Hongwei*

Second affiliated hospital of nanjing university of traditional Chinese medicine，Nanjing 210017，China

[Abstract]

Objective：By MRI （mri） to investigate the asymptomatic vertebral hemangioma （VH） outcome may，to guide the prevention and treatment of asymptomatic vertebral hemangioma.Methods：MRI was performed again by 160 cases once diagnosed by MRI with vertebral hemangioma. According to the previous magnetic resonance image，the 160 patients were divided into 115 cases of aggressive VH and 45 cases of non-aggressive VH.All patients' previous and re-performed MRI were retrospectively analyzed on T1-weighted， T2-weighted and fat-suppressed MRI.Results：Of the 115 patients who were originally aggressive VH， 84 were non-aggressive after performing magnetic resonance reexamination again， and 31 were still aggressive.Among the 45 patients who were originally non-aggressive VH patients， 43 were still non-aggressive after performing magnetic resonance reexamination again， and 2 were self-healing.Conclusion：Patients with aggressive VH eventually progressed to non-aggressive progression （84/115，73.04%），with the possibility of symptom development （2/115， 1.74%）.Non-aggressive VH is more stable and asymptomatic （43/45， 95.56%）， and even self-healing （2/45， 4.44%）.This provides an important reference for the dynamic process， prevention and management of vertebral hemangioma.

[Key words]?Vertebral hemangiomas（VH）;Magnetic resonance imaging（MRI）;Aggressive;Asymptomatic

【中圖分類號】

R395【文獻標識碼】

B?【文章編號】2095-6851（2020）05-255-01

血管瘤是良性的緩慢生長的血管腫瘤，可能發生在身體的任何地方，包括骨骼。根據臨床表現可分為4類[1]：無癥狀無侵襲性，有癥狀無侵襲性，無癥狀有侵襲性，有癥狀有侵襲性。其中“侵襲性”血管瘤可以導致快速進行性脊髓壓迫綜合征。磁共振影像上，椎體血管瘤的T1、T2兩種加權影像上表現多樣，其不同主要取決于病灶內脂肪細胞、血管及間質水分的相對含量，本次研究中將病灶內血管及間質水分含量高于脂肪含量歸于侵襲性，即T1加權為長或等信號，T2加權為長信號，脂肪抑制像為高信號。

根據我們的研究，侵襲性無癥狀性椎體血管瘤存在著產生癥狀的風險，臨床上應加以重視，加強對該類患者的隨訪，而非侵襲性無癥狀性椎體血管瘤的病灶趨于穩定，產生癥狀的可能性很低，對此類患者的隨訪是不必要的。MRI也由于其特性成為椎體血管瘤分類的主要依賴手段。我們對產生癥狀的椎體血管瘤采取經皮球囊擴張椎體后凸成形術，術后患者癥狀緩解明顯，療效確切。

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