脊柱结核骨质破坏、脓腔MSCT、MRI特点与临床病程的关系研究  

Study on the relationship between MSCT and MRI features of bone destruction,pus cavity and clinical course of spinal tuberculosis

作　　者：王姿丽 梁昆 杨长成[3] WANG Zili;LIANG Kun;YANG Changcheng(Department of Imaging,Bayannaoer City Hospital,Bayannaoer,Inner Mongolia 015000,China;Science and Education Section,Bayannaoer City Hospital,Bayannaoer,Inner Mongolia 015000,China;Department of Neurorehabilitation,Bayannaoer City Hospital,Bayannaoer,Inner Mongolia 015000,China)

机构地区：[1]巴彦淖尔市医院影像科,内蒙古巴彦淖尔015000 [2]巴彦淖尔市医院科教科,内蒙古巴彦淖尔015000 [3]巴彦淖尔市医院神经康复科,内蒙古巴彦淖尔015000

出　　处：《重庆医学》2023年第24期3779-3784,共6页Chongqing medicine

摘　　要：目的探讨脊柱结核骨质病变、脓腔多层螺旋CT(MSCT)和MRI的特点及其与脊柱结核临床病程的相关性。方法回顾性分析2016年9月至2022年6月该院经手术病理或临床证实为脊柱结核的33例患者MSCT、MRI表现,根据MSCT表现将脊柱结核骨质病变分为椎体正常型、溶骨型、骨碎片型和局灶硬化型4种类型,观察破坏区周围骨质MSCT密度和T1WI信号特点,脓腔强化及脊髓神经根的MRI特点。结果共分析74个病变椎体的MSCT和MRI表现,其中MSCT骨质表现正常7个(9.5%),溶骨型16个(21.6%),骨碎片型40个(54.0%),局灶破坏硬化型11个(14.9%),以骨碎片型最多。74个病变椎体中42个椎体有脓腔形成,其中骨质正常型0个、溶骨型6个、骨碎片型32个、局灶硬化型4个,不同骨质破坏类型脓腔构成比比较,差异有统计学意义(P<0.05),骨碎片型最易形成脓腔。骨质破坏区周围骨质MSCT密度和T1WI信号有分层特点,MRI增强扫描根据脓腔形态及脓腔周围骨质强化特点分为未形成脓腔、脓腔形成早期、脓腔进展期、脓腔愈合期,各期与脊柱结核病程相关。脊柱结核破坏区软组织肿胀或硬膜外脓肿压迫脊髓或马尾,感染蔓延到椎间孔引起神经根炎症。结论脊柱结核不同类型骨质病变的MSCT和MRI表现具有一定特征性,二者结合可以准确判断病变范围及推断病变发展进程。Objective To investigate the characteristics of spinal tuberculosis bone destruction,pus cavity multislice spiral computed tomography(MSCT) and MRI and their correlation with the clinical course of spinal tuberculosis.Methods MSCT and MRI findings of 33 patients with spinal tuberculosis proved pathologically or clinically in this hospital from September 2016 to June 2022 were retrospectively analyzed.According to CT findings,the bone lesions of spinal tuberculosis were divided into four types:normal vertebral body type,osteolytic type,bone fragment type and focal sclerosis type.CT density and T1WI signal characteristics of bone around the destruction area,pus cavity enhancement and MRI characteristics of spinal nerve root were observed.Results MSCT and MRI findings of 74 diseased vertebral bodies were analyzed.Among them,7(9.5%) were normal,16(21.6%) were osteolytic,40(54.0%) were bone fragment,and 11(14.9%) were focal destruction and sclerosis.Among the 74 diseased vertebral bodies,42 vertebral bodies had pus cavity formation,including 0 normal bone type,6 osteolytic type,32 bone fragment type and 4 focal sclerosis type.There was a statistically significant difference in the composition ratio of pus cavity between different bone destruction types(P<0.05),and bone fragment type was most likely to form pus cavity.MSCT density and T1WI signal of bone around the bone destruction area have stratification characteristics.According to the shape of the abscess cavity and the characteristics of bone enhancement around the abscess cavity,MRI enhanced scan is divided into non-forming abscess cavity,early formation of abscess cavity,advanced stage of abscess cavity and healing stage of abscess cavity.Soft tissue swelling or epidural abscess in the spinal tuberculosis destruction area compresses the spinal cord or cauda equina,and the infection spreads to the intervertebral foramen to cause nerve root inflammation.Conclusion MSCT and MRI manifestations of different types of bone lesions in spinal tuberculosis have certain ch

关 键 词：结核 脊柱 骨质正常 骨质破坏 多层螺旋CT 磁共振成像 死骨 结核脓腔 

分 类 号：R816.8[医药卫生—放射医学]