多节段布鲁菌性脊柱炎与脊柱结核MRI特征分析

doi:10.3969/j.issn.1004-583X.2021.04.012

摘要/Abstract

摘要：

目的探讨多节段布鲁菌性脊柱炎(BS)及脊柱结核(ST)在MRI中的不同影像特点,从而提高早期诊断及鉴别诊断水平。方法回顾性分析33例由临床或病理确诊为多节段BS患者、30例多节段ST患者,根据两者MRI表现,分析其发生部位、椎体形态、周围组织情况及伴随征象。结果多节段BS患者的椎体形态、椎间盘受累、后凸畸形、死骨及钙化、椎旁脓肿等所占比例与多节段ST患者的差异性具有统计学意义(P<0.05)。结论多节段BS与ST的MRI表现有不同征象,MRI有助于两者进行鉴别诊断。

关键词: 脊柱炎, 结核, 脊柱, 布鲁杆菌科, 磁共振成像

Abstract:

Objective To explore the different imaging characteristics of multi-segment brucella spondylitis (BS) and spinal tuberculosis (ST) in magnetic resonance imaging (MRI), so as to improve the level of early diagnosis and differential diagnosis. Methods Retrospective analysis was performed in 33 patients with multi-segment BS and 30 patients with multi-segment ST, who were diagnosed clinically or pathologically. Lesion location, vertebral body shape, surrounding tissues,and accompanying signs were studied according the different manifestations on MRI. Results The proportion of vertebral morphology, intervertebral disc involvement, kyphosis, sequestrum and calcification, paravertebral abscess were significantly different between the patients with multi-segmental BS and the patients with multi-segmental ST (P<0.05). Conclusion MRI findings of multi-segment BS and ST are different, MRI is helpful in differential diagnosis.

Key words: spondylitis, tuberculosis, spinal, brucellareae, magnetic resonance imaging

中图分类号:

R455.3

伍彦辉, 董春娇, 赵国芳, 郭立杰, 赵辉, 邢卫红. 多节段布鲁菌性脊柱炎与脊柱结核MRI特征分析[J]. 临床荟萃, 2021, 36(4): 348-352.

Wu Yanhui, Dong Chunjiao, Zhao Guofang, Guo Lijie, Zhao Hui, Xing Weihong. MRI features of multi-segmental brucella spondylitis and spinal tuberculosis[J]. Clinical Focus, 2021, 36(4): 348-352.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.04.012

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I4/348

图/表 4

表1 两组实验室检查比较[例(%)]

组别	例数	血沉25~ 100 mm/1 h	超敏C反应蛋白7.32~ 164 mg/L	血清凝集试验,滴度均>1∶100	琥红平板凝集试验	特异抗体 IgM/TgG (+)	PPD试验阳性率	血清抗结核抗体阳性率	T-SPOT.TB	穿刺活检确诊
BS组	33	19(57.6)	25(75.8)	33(100)	28(84.8)	18(54.5)	0	0	0	2(6.1)
ST组	30	18(60.0)	22(73.3)	0	0	0	16(53.9)	14(45.4)	26(87.5)	4(13.3)
χ²值		0.004	0.005	59.055	42.446	20.314	20.861	17.192	45.187	0.305
P值		>0.05	>0.05	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	>0.05

图1~4均为BS 图1 L2-3椎体片状长T2信号,椎体形态未见异常,椎间隙略变窄;图2 腰椎各椎体边缘可见骨赘形成,L3~4椎体前缘可见骨桥形成,椎间盘形态正常;图3 椎体前缘增生呈“花边椎”,周围软组织增厚,可见多发厚壁小脓肿,双侧腰大肌受侵;图4 L4椎体下缘及L5椎体上缘存在骨质破坏,椎体T2WI呈不均匀高信号,棘间韧带受累

图5~8均为ST 图5 腰椎结核,双侧腰大肌广泛脓肿形成呈“泪滴状”;图6 椎体多发薄壁脓肿,累及双侧腰大肌,增强后脓肿壁环形强化;图7 胸椎结核,椎体信号混杂,多发骨质破坏,椎体后凸畸形,椎管受压;图8 椎体多发骨质破坏,椎间隙消失,椎旁软组织增厚伴脓肿,病变明显不均匀强化

表2 两组MRI影像学特征比较[例(%)]

组别	例数	椎体塌陷畸形	后突畸形	椎体增生硬化	椎间盘狭窄及破坏	椎旁脓肿	钙化或死骨
BS组	33	12(36.1)	5(15.2)	21(64.1)	10(30.2)	12(36.3)	2(6.1)
ST组	30	22(73.2)	12(40.2)	7(23.3)	18(60.4)	2(7.2)	8(27.4)
χ²值		8.646	4.952	10.338	5.613	8.018	4.997
P值		0.005	0.045	0.002	0.024	0.006	0.038

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