【病例】椎管内硬膜外血管瘤1例MR影像表现

病史A 41-year-old woman presenting as numbness and tingling in the abdomen, thighs, and feet for the last 3–4 weeks. Brain MRI was unremarkable. MRI of the thoracic spine was performed with contrast.

41岁女性，腹部、双下肢、双足麻木并伴有刺痛感3-4周。颅脑MRI未见明显异常。胸椎MRI增强扫描如下图所示。

图例Noncontrast sagittal T1WI (A), sagittal T2WI (B), and contrast-enhanced sagittal T1WI (C) demonstrate a hyperintense T2, iso/hypointense T1 mass in the posterior epidural space of the thoracic spine that appears to displace the dura anteriorly, particularly at levels T5 and T6. Contrast-enhanced axial T2WI (D, top) and axial T1WI (D, bottom) through the thoracic spine show a hyperintense T2 mass enhancing homogenously, with compression of the thoracic spinal cord. Bilateral foraminal extension is seen.

矢状位T1WI、T2WI平扫及增强扫描T1WI矢状位可见：约T5-T6水平胸椎管后部硬膜外间隙内肿块，T1WI呈等/低信号，T2WI呈高信号，相应水平硬膜囊受压向前移位。

增强后横断位T2WI和T1WI示：肿块呈长T2信号，脊髓受压，并可见双侧椎间孔扩大。

Spinal Epidural Hemangioma

椎管内硬膜外血管瘤

背景Epidural hemangiomas (EH) are extremely rare, benign lesions. Several types have been described, most commonly cavernous and capillary.

硬膜外血管瘤是一种罕见的良性病变，文献报道中有多种病理类型，最常见的是海绵状血管瘤和毛细血管瘤。

临床表现Sudden onset of localized pain, slowly progressing paraparesis, radiculopathy, and focal neurological symptoms are likely due to the proximity of EH to neural structures and the likelihood for neural compression.

硬膜外血管瘤压迫神经可造成突发局部疼痛、缓慢加重性截瘫、神经根症状、局部神经系统症状。出现上述症状时，要考虑到神经受压的可能性。

影像诊断要点

Lobulated margins, increased T2 signal with rim of low T2 signal intensity, and robust enhancement are helpful in the diagnosis.
边缘呈分叶状，T2WI高信号，周边可见低信号环。增强扫描明显强化可有助于诊断。
Spinal MRI is the best diagnostic tool, and surgical excision confirms the diagnosis.
脊柱MRI是最佳诊断方法，最终确诊需依靠手术病理。

鉴别诊断

Schwannoma
许旺氏细胞瘤
Lymphoma
淋巴瘤
Granulomatous infections
炎性肉芽肿
Meningioma
脊膜瘤
Angiolipomas
血管脂肪瘤
Multiple myelomas
多发性骨髓瘤
Pure epidural hematomas
单纯硬膜外血肿
Epidural extramedullary hematopoiesis
硬膜外髓外造血

治疗要点

Open surgery is the best treatment to address any pain or neurologic symptoms. There is increased risk of intraoperative bleeding.
如有疼痛或神经症状，手术是最好的治疗方法。术中出血的几率较高。
Stereotactic radiosurgery has been used as adjuvant therapy for incompletely resected hemangiomas, though more studies on its effectiveness are necessary.
部分研究认为立体定向放疗有很好的治疗效果，可作为不完全切除术后的辅助治疗。

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