Okubo Toshiki, Nagoshi Narihito, Tsuji Osahiko, Tachibana Atsuko, Kono Hitoshi, Suzuki Satoshi, Okada Eijiro, Fujita Nobuyuki, Yagi Mitsuru, Matsumoto Morio, Nakamura Masaya, Watanabe Kota
Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Orthopaedic Surgery, Keiyu Orthopaedic Hospital, Gunma, Japan.
Global Spine J. 2023 Mar;13(2):276-283. doi: 10.1177/2192568221994799. Epub 2021 Mar 11.
Retrospective cohort study.
Intraspinal solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is often misdiagnosed preoperatively as schwannoma or meningioma because its imaging characteristics are not well understood. As postoperative prognosis differs among the 3 lesions, predicting the probability of SFT/HPC preoperatively is essential. Thus, this study investigates the imaging characteristics of SFT/HPC compared with those of schwannoma or meningioma and evaluates surgical outcomes.
The preoperative imaging findings, tumor resection extent, recurrence and regrowth rates, and neurological improvement were compared between 10 patients with SFT/HPC and 42 patients with schwannoma or 40 patients with meningioma.
Most patients with SFT/HPC showed isointensity on both T1- and T2-weighted images compared with patients with schwannoma ( = 0.011 and 0.029, respectively) and no significant difference compared with patients with meningioma ( = 0.575 and 0.845, respectively). Almost all patients with SFT/HPC showed highly uniformizing enhancement patterns, similar to those with meningioma ( = 0.496). Compared with meningioma, SFT/HPC lacked the dural tail sign and intratumoral calcification and exhibited irregular shape. Of the 5 patients who underwent partial resection, 60% exhibited tumor recurrence and regrowth following surgery.
Complete surgical resection should be attempted in patients with intraspinal SFT/HPC to prevent postoperative recurrence or regrowth. As this tumor is often preoperatively misdiagnosed, we recommend that the imaging findings exhibited in this study should be used to positively suspect SFT/HPC. This will enhance patient outcomes by enabling more appropriate preoperative surgical planning.
回顾性队列研究。
脊髓内孤立性纤维瘤（SFT）/血管外皮细胞瘤（HPC）术前常被误诊为神经鞘瘤或脑膜瘤，因为其影像学特征尚未得到充分了解。由于这三种病变的术后预后不同，术前预测SFT/HPC的可能性至关重要。因此，本研究调查了SFT/HPC与神经鞘瘤或脑膜瘤相比的影像学特征，并评估手术结果。
比较10例SFT/HPC患者与42例神经鞘瘤患者或40例脑膜瘤患者的术前影像学表现、肿瘤切除范围、复发和再生长率以及神经功能改善情况。
与神经鞘瘤患者相比，大多数SFT/HPC患者在T1加权和T2加权图像上均表现为等信号（分别为P = 0.011和0.029），与脑膜瘤患者相比无显著差异（分别为P = 0.575和0.845）。几乎所有SFT/HPC患者均表现出高度均匀的强化模式，与脑膜瘤患者相似（P = 0.496）。与脑膜瘤相比，SFT/HPC缺乏硬膜尾征和瘤内钙化，且形状不规则。在接受部分切除的5例患者中，60%在术后出现肿瘤复发和再生长。
对于脊髓内SFT/HPC患者，应尝试进行完整的手术切除以防止术后复发或再生长。由于这种肿瘤术前常被误诊，我们建议应利用本研究中展示的影像学表现来积极怀疑SFT/HPC。这将通过实现更合适的术前手术规划来提高患者的治疗效果。
