脊柱结核的CT诊断

CT Findings of Spinal Tuberculosis

目的探讨脊柱结核的CT表现及脊柱结核CT检查的重要意义。方法对30例临床和病理确诊的脊柱结核病例的CT表现进行回顾性分析。结果脊柱结核的CT表现包括:(1)椎体及附件不规则虫蚀样和囊状骨质破坏。(2)沙砾样和斑片样死骨形成。(3)椎间盘坏死及椎间隙狭窄、消失。(4)椎旁脓肿、纵隔脓肿、腰大肌脓肿。(5)椎体后部的骨质破坏产生的碎骨片和坏死物质可进入椎管压迫硬膜囊和神经根。(6)椎体塌陷呈楔形。结论CT对脊柱结核的诊断和鉴别诊断有重要价值,尤其脊柱结核对椎体附件和椎管的累及范围、程度可清楚地显示,对指导手术治疗和判断预后有重要意义。

Objective To describe the CT manifestations of spinal tuberculosis and assess the significance of CT examination in the diagnosis and the treatment of spinal tuberculosis. Methods The CT findings of spinal tuberculosis confirmed clinically and pathologically in 30 cases were retrospectively analyzed. Results The CT appearances of spinal tuberculosis in the 30 cases include： （ 1 ） irregular cystic and eroded bone destruction in vertebral bodies, pedicles and laminas, （2） bone sequestmm formation, （3） disc necrosis and disc space narrowing, （4） paraspinal abscess, psoas abscess and mediastinal abscess, （5） neurological involvement, i.e. dissemination of necrosis and bony fragments into spinal canal, and （6） vertebral body collapse. Conclusion CT has a high value in the diagnosis and the treatment of spinal tuberculosis, and axial CT is the most accurate method for visualizing the posterior bony elements in spine.