结核性关节炎与化脓性关节炎的MR诊断价值  

Discrimination of tuberculous arthritis from pyogenic arthritis on MRI

作　　者：方挺松[1] 周守国[1] 樊长姝[1] 

机构地区：[1]广州中医药大学附属佛山市中医院放射科,广东佛山528000

出　　处：《医学影像学杂志》2010年第3期417-420,共4页Journal of Medical Imaging

摘　　要：目的:探讨MRI在结核性关节炎与化脓性关节炎鉴别诊断中的作用。方法:回顾性总结经细菌培养或组织学病理检查证实的结核性关节炎10例、化脓性关节炎13例的MRI影像表现,分析两者影像表现的差异。结果:结核性关节炎多表现为骨的侵蚀破坏(6例),化脓性关节炎则多表现为关节面骨质破坏同时合并关节面下的骨髓信号异常(8例);结核性关节炎关节周围炎症病灶的边界相对光滑清楚(7例),增强扫描脓肿壁常常表现为薄壁、光滑的强化(7例),而化脓性关节炎易向关节周围扩散以致病灶边界不规则(10例),增强扫描可见脓肿壁表现为厚壁、不规则强化(6例)。两者均可见关节滑膜增生或关节积液,在T2WI表现为中等或高信号。结论:MRI检查在鉴别结核性关节炎以及化脓性关节炎中可提供可靠的信息。Objective：To access the accuracy of MRI for discrimination between tuberculous arthritis and pyogenic arthritis.Methods：MRI features of 13 patients with tuberculous arthritis and 10 patients with pyogenic arthritis confirmed microbiologically or histopathologically were retrospectively reviewed.Results：MRI images showed bone erosion in 6 cases with tuberculous arthritis,while bone erosion with bone marrow signal intensity abnormality was seen more frequently in pyogenic arthritis（8 cases）.A well-defined extraarticular infectious lesions（7 cases） and thin and smooth rim enhancement（7 cases） of abscess were seen in patients with tuberculous arthritis.A ill-defined extraarticular infectious lesions（10 cases） and thick and irregular rim enhancement of abscess（6 cases） were seen in patients with pyogenic arthritis.T2-weighted images showed variable intermediate-to high-signalintensity lesions in synovial abnormalities or joint fluid of tuberculous arthritis and pyogenic arthritis.Conclusion：MR imaging provides useful information in the discrimination between tuberculous arthritis and pyogenic arthritis.

关 键 词：关节炎 结核 化脓性 磁共振成像 

分 类 号：R684[医药卫生—骨科学] R445.2[医药卫生—外科学]