老年人脊柱结核的CT和MRI诊断

CT and MRI diagnosis of spinal tuberculosis in the senile patient

目的探讨老年人脊柱结核的CT和MRI表现。方法对经手术病理或抗结核治疗证实的50例老年人脊柱结核行CT检查,其中35例同时行MRI检查。结果老年人脊柱结核的CT表现为椎体的骨质破坏,分为溶骨状、虫蚀状及碎裂状三种形式,39例分布于椎体上、下缘的前方、侧方的外1/3带,11例累及全椎体,19例可见硬化边,21例可见砂粒状死骨,13例可见椎旁脓肿。MRI表现为椎体边缘的骨质破坏,常累及相邻椎体上、下缘,呈T1WI低中等信号、T2WI高信号,破坏区周围可见不同程度的水肿区,呈T1WI低信号、T2WI等高信号,椎间隙变窄21例,其中13例椎间盘出现T2WI高信号,椎旁脓肿表现为边缘不清的T1WI低中等信号T2WI高信号。结论CT与MRI结合可全面反映老年人脊柱结核的影像学及病理特点,对正确诊断及指导临床治疗有重大意义。

Objective To evaluate CT and MRI findings of spinal tuberculosis in senile patients. Methods All 50 senile patients with spinal tuberculosis received CT scan, and additional MRI was performed in 35 patients out of the 50. All cases were confirmed by operation and pathology or anti -tuberculotic therapy. Results The CT demonstrated bone destruction in vertebral bodies. CT scan showed osteolytic, cribriform or fragmentary bone destruction. The lesion was located at the peripheral 1/3 of the vertebral body adjacent the margin in 39 cases out of 50, and involved the whole vertebral body in 11 cases. Osteosclerotic borderlines were shown in 19 cases. Gravel sequestrum was revealed in 21 cases and paraspinal abscess was demonstrated in 13 cases. Bone destruction were isointense on T1WI and hyperintense on T2WI in 35 cases. There were various intensities of edema surrounding the lesions, which were hypointense on T1WI and isointense or hyperintense on T2WI. Intervertebral space narrowing was demonstrated in 21 cases, in which the intervertebral disk was hyperintense on T2WI in 13 cases out of 21. Paraspinal abscess was poorlu demarcated and manifested hypointense on T1WI and hyperintense on T2WI. Conclusion CT and MRI provide comprehensive imaging findings as well as reveal the pathological features of the spinal tuberculosis in senile patients, which play an important role in an accurate diagnosis and clinical management.