骨关节结核的影像诊断与误诊分析

Imaging diagnosis and misdiagnosis of osteoarticular tuberculosis

目的提高对骨关节结核影像学表现的认识 ,避免误诊。方法回顾性分析 3 8例术前诊断骨关节结核的手术病理资料及影像学资料。结果本组术前影像学均诊断为骨关节结核 ,X线表现为骨质破坏、骨质疏松及相应部位软组织肿胀。CT表现为骨质破坏伴骨硬化缘环绕、死骨 ,冷脓肿形成及脓肿壁钙化。MRI表现为椎体骨炎、骨质破坏 ,或椎间盘破坏、椎间盘裂隙状强化及椎旁脓肿形成。手术病理证实 3 3例为结核病变 ,诊断符合率 86.8% ,其中脊柱结核 2 0例 ,髋关节结核 5例 ,腕关节、膝关节、踝关节、骶髂关节结核各 2例。结论骨关节结核的影像学表现有相对的特征性 ,合理选择影像学检查方法对提高骨关节结核的正确诊断率大有帮助。

Objective To improve knowledge of imaging findings of osteoarticular tuberculosis and to avoid misdiagnosis. Methods Retrospective analysis was performed on surgical pathological findings and imaging data from 38 cases of osteoarticular tuberculosis diagnosed preoperatively. Results All cases in this study were diagnosed with osteoarticular tuberculosis preoperatively by imaging.X-ray findings included:destruction of bone,osteoporosis,swelling of local soft tissues;CT findings were as follows:destruction of bone and surrounding osteosclerosis,sequestrum,formation of cold abscess and calcification of the wall;on MRI present were the following findings:vertebral osteitis and destruction of bone,destruction of interverbral disc;fissural enhancement of intervertebral disc;para-vertebral abscessation.33 cases of osteoarticular tuberculosis were comfirned by surgical pathology and the correspondence rate was 86.8%.Of these 33 cases,20 were suffering from tuberculosis of spine (n=20),5 from hip joint (n=5),2 from wrist joint (n=2),2 from knee joint (n=2),2 from ankle joint(n=2)and 2 from sacroiliac joint (n=2). Conclusions Rational choice of imaging examination would be very helpful to raising right diagnosis of osteoarticular tuberculosis.