脊柱结核的影像学诊断及临床病理分析

IMAGEOLOGY DIAGNOSIS OF SPINAL TUBERCULOSIS AND AN ANALYSIS ON THE CLINICAL PATHOLOBY

研究脊柱结核的影像学诊断价值,并探讨各型脊柱结核的临床病理特点。对156例经临床及病理证实且影像学资料完整的脊柱结核进行回顾性分析,比较其X线(或CR)、CT及MRI的影像学特点及符合率。结果显示①X线(或CR)、CT及MRI对脊柱结核诊断符合率分别为90.5%、96.2%及99.5%。②X线(或CR)、CT及MRI对椎体骨质破坏、椎间隙狭窄的敏感性分别为74.5%、89.9%及96.87%。③对椎旁软组织肿块和腰大肌脓肿、附件破坏及骨性椎管受累的显示,CT优于X线(和CR)片;对早期病变的显示及脊髓受累情况,MRI优于X线(或CR)及CT,有显著差异性(P<0.01)。④对死骨及钙化的显示CT优于X线(或CR)及MRI。认为X线(或CR)检查为诊断脊柱结核的基本方法,但对早期病变的显示有限度;CT显示早期微小的骨质破坏、死骨、脓肿、钙化及脓肿对椎管脊髓压迫明显优于X线;MRI可清晰显示硬膜外脓肿及脊柱后突畸形对脊髓的压迫和脊髓变性情况,尤其是对早期病变的诊断,有较高的敏感性和特异性,但对死骨及钙化不敏感。

The objective of the paper is to study the imageology-diagnosis value of spinal tuberculosis and to explore the clinical pathological characteristics of spinal tuberculosis of various types. One hundred and fifty-six cases of spinal tuberculosis confirmed by the clinical and pathological diagnosis and having complete imageology data were retrospectively analyzed; the imageology characteristics and coincidence rates of X-ray (or CR), CT and MRI examinations of these cases were compared. The results showed: ① the coincidence rates of the X-ray (or CR), CT and MRI diagnoses of spinal tuberculosis were 90.5%, 96.2 % and 99.5 %, respectively; ② the sensitivities of the X-ray (or CR), CT and MRI to the pyramidal bone destruction and intervertebral space stenosis were 74.5 %, 89.9 % and 96.87 %, respectively; ③ CT had an advantage over X-ray (or CR) film in showing paravertebral soft-tissue tumor, greater psoas muscle abscess, adnexal damage and bony spinal canal involvement, so did MRI over X-ray (or CR) and CT films in showing the early lesion and spinal-cord involvement with a significant difference (P<0.01); ④ so did CT over X-ray (or CR) and MRI in showing the sequester and calcification. It was believed: ① the X-ray (or CR) examination is the basic method for diagnosing spinal tuberculosis but has a limit in showing the early lesion; ② CT has an obvious advantage over the X-ray in showing the early slight bone destruction, sequester, abscess, calcification and the compression of the spinal canal or cord by the abscess; ③ MRI can clearly show the compression of the spinal cord by the epidural abscess and kyphosis deformity and the spinal cord degeneration, having a high sensitivity and specificity to the early lesion diagnosis but not to the sequester and calcification.