良性肿瘤包括大多数原发性椎骨肿瘤,这些通常是在成像时偶然发现的。尽管如此,这些良性病变的准确诊断至关重要,以避免误诊为更不祥的恶性病变或感染。此外,其中一些肿瘤,尽管它们是良性的,会对脊柱产生局部影响,包括神经受损,或者可以是局部侵略性的,因此需要积极管理。血管瘤和骨瘤是最常见的良性肿瘤。其他包括骨样骨瘤,成骨细胞瘤,纤维发育不良,骨软骨瘤,软骨母细胞瘤,血管瘤,单纯骨囊肿,动脉瘤骨囊肿,巨细胞瘤,嗜酸性肉芽肿和脊索休息。大多数病变是无症状的;然而,局部侵袭性病变(如动脉瘤性骨囊肿或巨细胞瘤)可表现为非特异性症状,如背痛,神经功能缺损和脊柱不稳定,这可能与更常见的机械性背痛或包括转移在内的恶性病变无法区分。因此,成像,包括射线照相,计算机断层扫描(CT)和磁共振成像(MRI),在诊断中起着至关重要的作用。一般来说,大多数偶然或无症状区域都是保守管理的,或者可能不需要任何随访,虽然有症状或局部侵袭性病变需要积极干预,其中包括手术切除或经皮治疗技术。由于近年来介入放射学技术的进步,经皮微创技术,如射频消融,硬化治疗和冷冻消融术在这些肿瘤的治疗中发挥了越来越重要的作用,并获得了良好的预后。本文将讨论不同类型的原发性良性椎骨肿瘤,重点是相关的影像学特征。
Benign tumours comprise the majority of primary vertebral tumours, and these are often found incidentally on imaging. Nonetheless, accurate diagnosis of these benign lesions is crucial, in order to avoid misdiagnosis as more ominous malignant lesions or infection. Furthermore, some of these tumours, despite their benign nature, can have localised effects on the spine including neural compromise, or can be locally aggressive, thus necessitating active management. Haemangiomas and osteomas (enostosis) are the commonest benign tumours encountered. Others include osteoid osteoma, osteoblastoma, fibrous dysplasia, osteochondroma, chondroblastoma, haemangioma, simple bone cysts, aneurysmal bone cysts, giant cell tumours, eosinophilic granuloma and notochordal rests. The majority of lesions are asymptomatic; however, locally aggressive lesions (such as aneurysmal bone cysts or giant cell tumours) can present with nonspecific symptoms, such as back pain, neurological deficits and spinal instability, which may be indistinguishable from more commonly encountered mechanical back pain or malignant lesions including metastases. Hence, imaging, including radiography, computed tomography (CT) and magnetic resonance imaging (MRI), plays a critical role in diagnosis. Generally, most incidental or asymptomatic regions are conservatively managed or may not require any follow-up, while symptomatic or locally aggressive lesions warrant active interventions, which include surgical resection or percutaneous treatment techniques. Due to advances in interventional radiology techniques in recent years, percutaneous minimally invasive techniques such as radiofrequency ablation, sclerotherapy and cryoablation have played an increasing role in the management of these tumours with favourable outcomes. The different types of primary benign vertebral tumours will be discussed in this article with an emphasis on pertinent imaging features.