MRI在布鲁氏菌病患者早期脊柱炎与ModicⅠ型脊柱退行性病变的鉴别诊断价值  

The value of MRI in differentiating Modic typeⅠspinal degenerative changes from early spondylitis in patients with brucellosis

作　　者：李俊林 丁海涛 王丽娜 尹松涛 赵楠 Li Junlin;Ding Haitao;Wang Lina;Yin Songtao;Zhao Nan(Department of Imaging Medical,The People's Hospital of Inner Mongolia Autonomous Region,Inner Mongolia Hohhot 010017,China;Department of Clinical Laboratory Medicine Center,The People's Hospital of Inner Mongolia Autonomous,Inner Mongolia Hohhot 010017,China;Department of Ultrasound,The People's Hospital of Inner Mongolia Autonomous Region,Inner Mongolia Hohhot 010017,China)

机构地区：[1]内蒙古自治区人民医院影像医学科,内蒙古呼和浩特010017 [2]内蒙古自治区人民医院临床检验医学中心,内蒙古呼和浩特市010017 [3]内蒙古自治区人民医院超声医学科,内蒙古呼和浩特010017

出　　处：《新发传染病电子杂志》2024年第6期26-31,F0002,共7页Electronic Journal of Emerging Infectious Diseases

基　　金：内蒙古医学科学院公立医院科研联合基金科技项目(2023GLLH0060);内蒙古自治区卫生健康委医疗卫生科技计划项目(202201054);内蒙古自治区医师协会临床医学研究和临床新技术推广项目(YSXH2024KYF001)。

摘　　要：目的探讨MRI在布鲁氏菌病患者早期脊柱炎与ModicⅠ型脊柱退行性病变(Modic typeⅠspinal degenerative changes,MⅠ)鉴别中的应用价值,为二者的鉴别诊断提供影像学参考依据。方法选取内蒙古自治区人民医院2020年1月至2024年5月期间收治的15例确诊为布鲁氏菌性脊柱炎(brucellosis spondylitis,BS)患者作为BS组,17例腰椎MⅠ患者作为MⅠ组,所有患者均行MRI检查,分别比较两组病变椎体及邻近椎间盘的形态、信号、骨质改变、强化的影像模式。结果BS组15例患者病变共累及椎体28个,平均年龄47.88岁;MⅠ组17例患者病变共累及椎体27个,平均年龄53.60岁。BS组病变好发于椎体:L_(4),占比28.57%(8/28);病灶以T_(1)WI低信号(13/28,46.43%)、T_(2)WI边界清楚(24/28,85.71%)、T_(1)WI终板轮廓线不连续(24/28,85.71%)为主;未发现DWI爪征阳性;MRI增强扫描病灶发生强化100%(17/17);部分椎体存在骨质破坏10.71%(3/28);病灶大部分为扇形或条形形态(23/28,82.14%);椎间盘T_(2)WI高信号占83.33%(15/18)。MⅠ组病变好发椎体:L_(5),占比33.33%(9/27),病灶以T_(1)WI等/低信号(18/27,66.67%)、T_(2)WI边界模糊(18/27、66.67%)、T_(1)WI终板轮廓线连续(22/27、81.48%)为主;T_(1)WI高信号的发生率11.11%(3/27);DWI爪征阳性100.00%(7/7);MRI增强扫描病灶发生强化100.00%(7/7);部分椎体存在骨质破坏14.81%(4/27);病灶扇形或条形形态为62.96%(17/27);椎间盘T_(2)WI高信号占比20.00%(3/15)。结论DWI爪征阳性,明确提示MⅠ;T_(1)WI终板轮廓线连续,MⅠ可能性大;累及椎间盘T_(2)WI高信号,BS可能性大;病灶中出现T_(1)WI高信号,提示MⅠ。以上特征对布鲁氏菌病患者早期脊柱炎与MⅠ的鉴别诊断有意义;病灶的形态和强化对二者的鉴别诊断价值不大,不推荐将其作为鉴别指标。Objective To explore the application value of MRI in the differential diagnosis of early spondylitis in brucellosis patients and Modic typeⅠspinal degeneration,and to provide imaging reference for the differential diagnosis of the two.Method Fifteen patients diagnosed with early brucellosis spondylitis admitted to the People's Hospital of Inner Mongolia Autonomous Region from January 2020 to May 2024 were selected as the BS group,and 17 patients with lumbar Modic typeⅠspinal degeneration were selected as the MⅠgroup.All patients underwent MRI examination.The morphology,signal,bone change and enhanced image pattern of the diseased vertebral body and adjacent discs of the two groups were compared respectively.Result The 15 patients in BS group had 28 vertebral body lesions,with an average age of 47.88 years.A total of 27 vertebral bodies were involved in 17 patients in MⅠgroup with an average age of 53.60 years.Vertebrae prone to lesions in BS group:L_(4),accounting for 28.57%(8/28);The lesions were mainly characterized by hypointense on T_(1)WI(13/28,46.43%),clear boundary on T_(2)WI(24/28,85.71%)and discontinuous endplate contour on T_(1)WI(24/28,85.71%).No positive DWI claw sign was found.Lesion enhancement 100%(17/17);10.71%(3/28)of the vertebral bodies had bone destruction.Most lesions were fan-shaped or stripe-shaped(23/28,82.14%).T_(2)WI hyperintensity of intervertebral disc was 83.33%(15/18).In MⅠgroup,the lesion was L_(5),accounting for 33.33%(9/27),and the lesion was mainly isohypointensity such as T_(1)WI(18/27,66.67%).The incidence of hyperintense in T_(1)WI was 11.11%(3/27).The main lesions were blurred boundary on T_(2)WI(18/27,66.67%)and continuous endplate contour on T_(1)WI(22/27,81.48%).DWI claw positive 100%(7/7);Lesion enhancement 100%(7/7);Some vertebrae had bone destruction 14.81%(4/27);Segment or strip shape of the lesion 62.96%(17/27).Intervertebral disc T_(2)WI hyperintense accounted for 20.00%(3/15).Conclusion DWI claw sign is positive,indicating MⅠclearly.T_(1)WI endplate cont

关 键 词：布鲁氏菌病 脊柱炎 ModicⅠ型脊柱退行性病变 磁共振成像 

分 类 号：R378.5[医药卫生—病原生物学]