Imaging appearances of spinal Langerhans cell histiocytosis in adult

目的 探讨成人脊柱朗格汉斯组织细胞增生症(LCH)的影像学表现.方法 对29例成人脊柱LCH的影像表现进行分析,评估病变数目、部位、骨破坏形式、椎旁及椎管内情况、MRI信号及增强特点.结果 29例患者脊柱病变48处,其中颈椎26处、胸椎17处、腰骶椎5处;11例累及脊柱多节段.骨破坏累及椎体15例(15/29,51.72％),椎体和附件均累及14例(14/29,48.28％);34.48％(10/29)伴硬化边,13.79％(4/29)伴邻近骨硬化;75.86％(22/29)病变突破骨皮质;48.28％(14/29)合并椎体压缩,其中7例(7/29,24.13％)表现为扁平椎.T2WI呈等或低信号占57.89％(11/19),高信号占31.58％(6/19),混杂信号占10.53％(2/19);增强扫描94.12％(16/17)呈明显强化,5.88％(1/17)呈轻度强化.结论 成人LCH好发于颈椎;骨破坏以椎体为主;可累及多个脊柱节段、呈连续或跳跃分布,扁平椎不少见、骨破坏周围的骨硬化对提示诊断有一定帮助.Objective To explore the imaging appearances of adult Langerhans cell histiocytosis (LCH) in spine and improve the awareness of this disease.Methods Imaging appearances of 29 patients with adult LCH in spine confirmed by clinic and pathology were analyzed retrospectively and the lesions number,location,the type of bone destruction,paravertebral and intraspinal and MRI signal and enhancement characters were evaluated.Results The total sum of spine lesions was 48 including 26 cervical lesions,17 thoracic lesions and 5 lumbar-sacrum lesions among 29 cases,and 11 cases involved multiple segments.Bone destruction was located in vertebral body in 15 cases accounting for 51.72％ (15/29),and 14 cases involved posterior arch accounting for 48.28％ (14/29).Sclerosis rim was found in 10 cases (10/29,34.48％) and bone sclerosis was found in 4 cases (4/29,13.79％).75.86％ (22/29) LCH extended to paravertebral space and the incidence of compressed fracture was 48.28％ (14/29),4.13％ (7/29) appeared as vertebra plana.On T2-weighted image,LCH showed iso-or-hypointensity (11/19,57.89％),hyperintensity (6/19,31.58％),heterogenous signal (2/19,10.53％).On MR enhanced scan,94.12％ (16/17) cases was significant enhanced,5.88％ (1/17) was moderate enhanced.Conclusion Cervical was commonly found in adult LCH,and bone destruction was mainly in vertebrae.It may involve one or multiple spine segments and bone destruction may be continuous or skip distribution.Vertebra plana was not rare.Bone sclerosis around bone destruction may be helpful for diagnosing LCH.91392-13963