脊柱骨髓瘤和脊柱结核的CT鉴别诊断  

Differential diagnosis between myeloma and tuberculosis of the spine with CT

作　　者：竹青 

机构地区：[1]深圳市宝安区沙井预防保健所,广东深圳518104

出　　处：《实用医学影像杂志》2009年第3期176-178,共3页Journal of Practical Medical Imaging

摘　　要：目的分析脊柱骨髓瘤和脊柱结核的影像资料,以提高其鉴别诊断率。方法回顾分析18例脊柱骨髓瘤和27例脊柱结核的临床和CT资料。结果18例脊柱骨髓瘤共45个椎骨受累,呈现大片状或局限性溶骨性破坏,椎体变形27个,3例可见椎旁轻微软组织肿块。27例脊柱结核共有35个椎体受累,呈不规则虫蚀样骨质破坏,破坏区见死骨形成的有9例,20例伴发明显的腰大肌脓肿和椎旁脓肿,10例伴发椎间盘坏死、椎间隙狭窄。结论脊柱骨髓瘤和脊柱结核各有一定的特征性表现,当难以鉴别时,临床、影像表现、实验室检查及病理相结合是提高其鉴别诊断的途径。Objective to analyze the imaging data of the spinal myeloma （SML） and spinal tuberculosis （STB） and to elevate the accuracy of the differential diagnosis.Methods The clinical and CT data collected from 18 SML patients and 27 STB patients were retrospectively analyzed.Results CT scans demonstrated that total 45 vertebral bodies of 18 SML patients were involved,which appeared as large patchy or localized osteolytic destruction,of whom,27 had deformity of vertebral bodies and 3 had mass of paravertebral soft tissue, while among 27 STB patients,total 35 vertebral bodies were involved,which appeared as irregular or bit like bone destruction,of whom ,9 had sequestration in destruction areas,20 has obvious proas abscess and paravertebral abscess,and 10 had intervertebral disc necrosis and intervertebral space norrowing.Conclusion The both of SML and STB have self existent imaging features,when the differentiation of the both is difficult,the integration of clinical data,imaging findings,laboratory tests and pathology can significantly elevate the accuracy of the differential diagnosis.

关 键 词：脊柱 骨髓瘤 结核 体层摄影术 X线计算机 鉴别诊断 

分 类 号：R738.1[医药卫生—肿瘤] R529.2[医药卫生—临床医学] R816.8