布氏杆菌性脊柱炎的CT和MRI表现

Analysis of CT and MRI features of Brucellar spondylitis

目的:探讨布氏杆菌性脊柱炎(BS)的CT和MRI表现,以提高对该病的认识。方法:收集经流行病学、影像学、实验室及病理检查确诊的70例BS患者的相关资料,并分析其CT和MRI表现。结果:70例BS患者共累及172个椎体,其中累及腰椎123个(71.51%),尤以下腰椎受累为著,骶椎18个(10.47%),胸椎17个(9.88%),颈椎14个(8.14%);累及相邻2个椎体46例(65.71%),相邻3个及以上椎体21例(30%,最多累及连续5个椎体),"跳跃征"3例(4.29%)。影像表现:虫蚀状骨质破坏伴骨质增生硬化最常见(96/172,占55.81%);大片状骨质破坏较虫蚀状骨质破坏更容易发生死骨(86.36%vs 13.64%)、椎体压缩(85.71%vs 14.29%)及后凸畸形(100%vs 0%)。椎间隙多正常(25/70,35.71%)或轻度狭窄(25/70,35.71%),可伴有"周围真空现象"(11/70,15.71%),终板破坏呈"类许莫氏结节"(32/70,45.71%);局限性椎旁脓肿和硬膜外脓肿分别占85.42%(41/48)和88.10%(37/42),仅6例脓肿内可见钙化;累及背部竖脊肌3例,累及前纵韧带、后纵韧带、马尾及终丝均为1例。结论:BS好发于下腰椎,影像上多表现为相邻椎体虫蚀状骨质破坏伴骨质增生硬化,椎间隙多正常或轻度狭窄,椎旁脓肿与硬膜外脓肿均较局限;BS的CT和MRI表现具有一定特征,结合流行病学、实验室检查及临床表现可作出诊断及鉴别诊断。

Objective:To investigate the CT and MRI features of brucellar spondylitis(BS)and to improve the understanding of this disease.Methods:Relevant data of 70 patients with BS confirmed by epidemiology,imaging,laboratory and pathological examination were collected,and their CT and MRI features were analyzed.Results:A total of 172 vertebrae were involved in 70 patients with BS,including 123 lumbar vertebrae(71.51%),especially the lower lumbar vertebrae,18 sacral vertebrae(10.47%),17 thoracic vertebrae(9.88%),and 14 cervical vertebrae(8.14%).Forty-six cases(65.71%)were involved two adjacent vertebral bodies,21 cases(30%)involved three or more adjacent vertebral bodies,up to five consecutive vertebral bodies,and 3 cases(4.29%)had"jumping sign".Image findings:The moth-eaten bone destruction with hyperosteogeny and osteosclerosis was the most common appearance(96/172,55.81%).Compared with the moth-eaten bone destruction,massive bone destruction was more prone to osteonecrosis(86.36%vs 13.64%),vertebral compression(85.71%vs 14.29%)and kyphosis(100%vs 0).The disc spaces were mostly normal(25/70,35.71%)or slightly narrowed(25/70,35.71%),accompanied by"peripheral vacuum phenomenon"(11/70,15.71%).The destruction of vertebral endplate mimicked Schmorl’s nodes(32/70,45.71%).Limited paravertebral abscess and epidural abscess accounted for 85.42%(41/48)and 88.10%(37/42),respectively.Calcification was found in only 6 cases of abscess.The lesions involved the back erector spinae in 3 cases.The anterior longitudinal ligament,posterior longitudinal ligament,cauda equina and terminal filament were involved in 1 case respectively.Conclusion:BS mainly occurs in the lower lumbar spine,and its imaging features are moth-eaten bone destruction with hyperosteogeny and osteosclerosis of adjacent vertebral bodies,normal or slight stenosis of disc space,limited paravertebral abscess and epidural abscess.Diagnosis and differential diagnosis can be made by combining epidemiology,laboratory examination and clinical manifestations.