成人脊椎结核的不典型MRI表现

Atypical MRI features in adult′s tuberculosis of the spine

目的 :探讨成人脊椎结核的不典型MRI表现 ,评价MRI对其病理特征的显示能力。方法 :回顾性分析 17例患者的MRI表现 ,其中 12例经病理证实 ,5例经抗结核治疗证实 ,结合X线平片、CT ,分析椎体、椎间盘、椎体周围软组织、椎管内硬膜外腔的形态、结构、MR信号变化及Gd DTPA增强后的强化形式。结果 :共 3 9个病椎 ,其中 13个虫蚀状骨质破坏 ,3 9个椎体骨炎 ;17例椎体周围软组织肿胀 ,并椎旁、椎前脓肿 7例 ;T2 WI病椎椎间盘邻近破坏终板裂隙状高信号 8个 ,Gd DTPA增强表现为裂隙状强化 ;病椎后硬膜外脓肿 8例 ,Gd DTPA增强后脓肿壁、后纵韧带线样强化。结论 :椎体骨炎、病椎虫蚀状骨质破坏、椎体周围软组织肿胀、T2 WI椎间盘邻近破坏终板裂隙状高信号、病椎后硬膜外脓肿、Gd DTPA增强检查椎体的环状或结节状、椎间盘裂隙状、后纵韧带线状强化等是AATS富有特征性的MRI表现。

Objective:To study the atypical MRI features of adult′s tuberculosis of spine and evaluate the ability of MRI to demonstrate the pathology of the disease.Methods:In combination with the radiography and CT,the MRI features of 17 cases with AATS,12 cases of them were proven by surgery or biopsy and 5 cases confirmed by clinical therapy,were reviewed.Their shapes,structures and changes of MR signal intensity of the vertebral bodies,intervertebral discs,paraspinal soft tissues and epidural spaces and patterns after Gd DTPA enhancement were analyzed.Results:There were “worm eaten” destructions in 13 of 39 vertebral bodies and 39 vertebral bodies showed osteitis.There were paraspinal soft tissue edema in 17 cases,and paraspinal abscesses in 7 cases.In 8 intervertebral discs adjacent to destructive end plates it showed fissural hyperintense signals on T 2 weighted images and being enhanced after Gd DTPA enhancement.There were small epidural abscesses at the posterior margins of the involved vertebra in 8 cases and the walls of abscesses and posterior longitudinal ligaments were enhanced after Gd DTPA enhancement.Conclusion:The above mentioned MRI features of tuberculosis of spine are characteristic.The MRI examination can well demonstrate pathological changes of AATS.