MRI在诊断早期和非典型脊柱结核中的价值探讨  

Diagnostic Value of MR Imaging in Early and Atypical Tuberculous Spondylitis

作　　者：赵林伟[1] 杨国庆[1] 董国礼[2] 敬宗林[2] 曾南林[2] 

机构地区：[1]四川省遂宁市中心医院放射影像科,四川遂宁629000 [2]川北医学院附属医院放射科,四川南充637000

出　　处：《中国CT和MRI杂志》2013年第4期107-110,共4页Chinese Journal of CT and MRI

基　　金：四川省卫生厅科研课题(编号:100153)

摘　　要：目的探讨早期和非典型脊柱结核的MRI特征及其在脊柱结核诊断和鉴别诊断中的价值。资料与方法收集经手术病理和随访证实的38例脊柱疾病的MRI资料(早期和非典型脊柱结核31例,其它疾病误诊为早期脊柱结核7例),由两位有经验的放射学医师共同分析所有病例的MRI图像特征。结果早期脊柱结核,MRI上可见椎体终板和邻近终板下骨质局限性破坏;椎间盘信号不均匀,其内可有干酪样物或小脓肿形成;椎旁软组织肿胀和硬膜外小脓肿形成。非典型脊柱结核包括连续或跳跃性骨质破坏、单椎体病灶,骶骨破坏并椎旁实性软组织肿块形成,孤立椎弓受累。结论早期和非典型脊柱结核的MRI表现变化多样,MRI可清楚显示早期脊柱结核的椎体和终板破坏、早期椎间盘炎、硬膜外小脓肿和椎旁软组织肿胀等病理特征以及非典型脊柱结核的病变情况,有助于脊柱结核与肿瘤和化脓性脊柱炎的鉴别。Objective To investigate MR imaging features of early and atypical tuberculous spondylitis and to find features that may help diffe,＇entiating tuberculosis from other spinal diseases. Material and Method Retrospective review of 38 MR imaging of patients with pathologically and follow-up proven. Thirty-one patients were diagnosed as early or atypical tuberculous Spondylitis. and 7 other patients were misdiagnosis as early tuberculosis spondylitis. All images were reviewed by two qeuroradiologists. Result In the early stage of spinal tuberculosis, endplate a,ad bone adjacent the vertebral endplate were destroyed limited.The signal of intervertebral disc was not homogenous. Caseating Lesions and/or small cystiform abcess may occur in the inw）lved disc.The paraspinal soft tissue edema or postvertebral epidural abscess was formed. Atypical forms of spinal tuberculous include single body disease, contiguous vertebrae or skip lesion, destructive lesion of the sacrum with palpable mass, isolated tubex＇culous involvement of the posterior elements of spine. Conclusion The MRI can dearly demonstrate pathologica features of early tuberculous spondylitis, including endplate and bone adjacent the vertebral endplate disruption, early discitis, paraspinal soft tissue edema or postvertebral epidural abscess. And the lesions of atypical tuberculous spondylitis can be demonstrated dearly also. On the other hand, the MRI is helpfnl to differentiate tuberculous spondylitis from tumor and pyogenic spondylitis.

关 键 词：结核 脊柱炎 磁共振成像 

分 类 号：R681.5[医药卫生—骨科学] R445.2[医药卫生—外科学]