How to judge whether it is an intraspinal tumor? What tests should I do?

The dynamic changes and protein content increase of cerebrospinal fluid after spinal puncture and cerebrospinal fluid examination are important basis for early diagnosis of intraspinal tumors. When intraspinal tumors are suspected, Quiken test and cerebrospinal fluid examination should be performed as soon as possible. Routine serial examination of cerebrospinal fluid in patients with intraspinal tumors can find that the protein content in cerebrospinal fluid is increased and the cell number is normal. Dynamic examination (i.e. Quiken test) can show partial or complete obstruction.

About 30% ~ 40% patients can see bone changes on X-ray plain films. On the conventional anteroposterior and oblique radiographs of the spine, the common signs are: (1) enlargement or destruction of intervertebral foramen; (2) Enlargement of spinal canal, manifested by widening of pedicle spacing; (3) Bone changes of vertebral body and its accessories, such as bone defect of vertebral body and pedicle destruction; (4) Calcification in spinal canal, occasionally seen in a few meningiomas, teratomas and hemangioblastomas; (5) Paravertebral soft tissue shadow. Because most tumors in the spinal canal are benign, there are often no bone abnormalities on the early X-ray films, and sometimes only in the late stage can indirect signs such as widening of pedicle spacing, thinning of cortical bone on the spinal canal wall and enlargement of the spinal canal be seen. For internal tumors such as dumbbell-shaped vertebrae, the intervertebral foramen is enlarged. X-ray examination can rule out spinal deformity and spinal cord compression caused by tumor, and it is still an essential routine examination.

At present, myelography is one of the effective methods to display space occupying lesions in spinal canal. Cervical myelography can use lipiodol (such as iodobenzene ester) or iodine water contrast agent (such as amipik or Onepik), especially by injecting drugs into the cistern of cerebellum and medulla oblongata, which is easy to diagnose. It shows that the contrast agent has a cup-shaped defect or obstruction on the non-intervertebral disc plane. Literature reported neurilemmoma 180 cases, of which 150 cases showed that the filling defect was cup-shaped 106 cases, horizontal section 18 cases, oblique cone-shaped 7 cases, trumpet-shaped 5 cases and beaded 4 cases. Omnipaque is the second generation nonionic iodine water-soluble contrast agent, which is clear, safe and reliable. Spinal cord tumor can be determined according to spinal cord enlargement, displacement and subarachnoid obstruction, and the correct diagnosis can be made by combining with the increase of cerebrospinal fluid protein. Because of adhesion and other reasons, sometimes the obstruction plane does not necessarily represent the real boundary of the tumor. Ni Bin et al. reported that 137 cases of intraspinal tumors, there were 4 cases whose obstruction planes were different from the results of surgical exploration 1/4 ~ 1 vertebral body. Unless a second radiograph is taken, a single radiograph can only determine the upper or lower boundary of the tumor, and the nature of the tumor cannot be determined only by the form of obstruction and bone involvement. However, myelography can determine the lesion site, and then ct scanning or mri examination can get more information about tumor lesions.

Ct scan has sensitive density resolution, can clearly show the spinal cord, nerve roots and other tissue structures on the cross section, and can clearly show the soft tissue shadow of seed tumor, which is helpful for the diagnosis of intraspinal tumors, which is not available in traditional imaging methods. However, the location of ct scanning, especially as the first imaging examination, needs to be determined according to clinical signs. It is possible to miss the tumor site because of inaccurate positioning. Ct can basically determine the segmental distribution and lesion range of intraspinal tumors, but it is difficult to distinguish them from normal spinal cord parenchyma. Ctm(ct plus myelography) can show the relationship between the whole spinal cord and tumors, and can distinguish tumors in the spinal cord from syringomyelia.

Magnetic resonance imaging is an ideal examination method, which has no side effects of ionizing radiation. It can observe the spinal cord image in three dimensions, show the boundary between tumor tissue and normal tissue, the location, size and scope of tumor, and directly outline the tumor, showing its longitudinal and transverse expansion and its relationship with surrounding tissue structure. It has become the first choice for diagnosis of spinal cord tumor. Mri has more advantages in differentiating intramedullary and extramedullary tumors. The Mri image of intramedullary tumor shows spinal cord enlargement, and the tumor shows different signal intensity under different pulse sequences, which can be distinguished from syringomyelia. Extramedullary tumors can be accurately located according to their relationship with dura mater. Mri sagittal imaging showed that the tumor was a well-defined long t 1 and long t2 signal area, but the tumor was mainly long t 1, and the enhancement effect was obvious, and some tumors were cystic. Axial images showed that the cervical spinal cord was compressed to one side, and the tumor was oval or crescent. For dumbbell-shaped tumors protruding through the intervertebral foramen, the continuity of the masses inside and outside the spinal canal can be seen. Because mri can directly perform sagittal imaging, the scope of spinal cord examination is larger than that of ct scan, which is incomparable, and mri can display the size, location and tissue density of tumor, especially the application of gd-dtpa, which can clearly display the outline of tumor, so mri is very important for diagnosis and surgical location, and ct or ctm is far less than mri in this respect.