Sugiyama A
Department of Radiology, Shizuoka Saiseikai General Hospital.
Nihon Igaku Hoshasen Gakkai Zasshi. 1994 Dec 25;54(14):1368-79.
Fifty patients with 63 symptomatic vertebral metastases (18 sites: pain only, 28 sites: radiculopathy with pain, 17 sites: myelopathy) were treated by radiotherapy. Primary lesions were located in the lung (9 cases), breast (9 cases) colorectal area (9 cases), prostate (7 cases) and so on. We correlated the radiologic findings, symptoms and clinical effects with metastatic features which were classified into 4 types by MR imaging: non-deformity, expanding, vertebral collapse, and destructive mass. Each type of metastasis was accompanied with or without epidural tumor. Osteolytic metastases were apt to create features of deformity (expanding type: 18 vertebrae, vertebral collapse type: 17 vertebrae, destructive mass type: 9 vertebrae). The features of osteoblastic metastases were no deformity (18 vertebrae) and expanding type (2 vertebrae). The symptom of pain only occurred most frequently in the lumbosacral spine. The vertebral body deformity of symptomatic sites was relatively slight (non-deformity type: 6 sites, expanding type: 6 sites, vertebral collapse type: 6 sites), and epidural tumors were seen at only 2 sites. The effect of radiotherapy was excellent (complete pain relief: 64.7%, partial pain relief: 29.4%). Radiculopathy occurred most frequently in the lumbar spine. Vertebral body deformity was noted in most symptomatic sites (expanding type: 9 sites, vertebral collapse type: 10 sites, destructive mass type: 2 sites). Complete relief was obtained in 6 sites (22. 2%), partial relief in 18 (63.0%). Myelopathy occurred most often in the thoracic spine, followed by the lumbar spine. The vertebral body deformity was severe (expanding type: 3 cases, vertebral collapse type: 3 cases, destructive mass type: 6 cases). Epidural tumors were also present in all but one case. Six of 13 patients treated with radiation alone improved. These 6 patients had non-deformity or expanding types with epidural tumor. No improvement was seen in the vertebral collapse type with epidural tumor or destructive mass type.
50例伴有63处有症状椎体转移瘤的患者（18处：仅疼痛，28处：伴有疼痛的神经根病，17处：脊髓病）接受了放射治疗。原发病变位于肺（9例）、乳腺（9例）、结直肠区（9例）、前列腺（7例）等。我们将放射学表现、症状及临床疗效与转移特征相关联，这些转移特征通过磁共振成像分为4种类型：无畸形、膨胀型、椎体塌陷型和破坏肿块型。每种转移类型均伴有或不伴有硬膜外肿瘤。溶骨性转移瘤易于形成畸形特征（膨胀型：18个椎体，椎体塌陷型：17个椎体，破坏肿块型：9个椎体）。成骨性转移瘤的特征是无畸形（18个椎体）和膨胀型（2个椎体）。仅疼痛症状最常发生于腰骶部脊柱。有症状部位的椎体畸形相对较轻（无畸形型：6处，膨胀型：6处，椎体塌陷型：6处），仅2处可见硬膜外肿瘤。放射治疗效果极佳（完全缓解疼痛：64.7%，部分缓解疼痛：29.4%）。神经根病最常发生于腰椎。大多数有症状部位可见椎体畸形（膨胀型：9处，椎体塌陷型：10处，破坏肿块型：2处）。6处（22.2%）获得完全缓解，18处（63.0%）获得部分缓解。脊髓病最常发生于胸椎，其次是腰椎。椎体畸形严重（膨胀型：3例，椎体塌陷型：3例，破坏肿块型：6例）。除1例患者外，其余患者均存在硬膜外肿瘤。13例仅接受放疗的患者中有6例病情改善。这6例患者为无畸形或膨胀型且伴有硬膜外肿瘤。伴有硬膜外肿瘤的椎体塌陷型或破坏肿块型患者未见病情改善。
