老年脊柱结核的CT与MRI表现对比分析

CT and MRI manifestations of spinal tuberculosis in elderly patients:a comparative study

目的观察并分析老年脊柱结核的CT与MRI表现。方法 CT设备采用美国GE公司生产的Light-speed64排螺旋CT机,扫描线平行于椎间隙,横断面扫描,层厚3mm,层距3mm,连续扫描脊柱可疑区,拍摄骨窗、软组织窗观察,必要时作增强扫描;MR检查设备选择Siemens公司生产的1.5Tsymphony超导磁共振扫描仪,扫描采用矢状面T1WI、T2WI序列和横轴面T2WI序列,部分病例行增强扫描,造影剂用马根维显(Gd-DT-PA)注射液,0.1mmol/kg静脉推注。结果 35例老年脊柱结核患者同时累及2个椎体19例占54.3%,累及>2个椎体14例,占40.0%,仅有2例为累及1个椎体;共累及椎体86个,累及部位:颈椎15个、胸椎19个、下胸椎11个、腰椎38个、骶椎3个;所有患者CT发现椎体伴椎间盘破坏、椎旁肿块或脓肿、硬膜外或椎孔侵犯、韧带下扩散、脊膜强化和钙化例数分别为35、30、5、1、1、25例,与CT相比MRI分别为35、30、15、20、16、2例。结论老年脊椎结核的CT以及MRI表现各有特点,临床综合分析CT以及MRI老年脊柱结核表现,对于其诊断及鉴别诊断、治疗有重要意义。

OBJECTIVE To observe and analyze the manifestations of CT and MRI in elderly patients with spinal tuberculosis.METHODS Lightspeed64 slice spiral CT machine manufactured by American GE Company was adopted.Scan lines were parallel to the intervertebral gap.The cross-section was scanned.The thickness of slice was 3 mm and the distance of layer was 3 mm.the suspicious spine area was scanned continuously,bone window was shot and soft tissue window was observed.The enhanced scanning was taken if necessary.MR imaging equipment was 1.5T symphony superconducting magnetic resonance scanner produced by Siemens.Scanning was taken for sagittal T1WI,T2WI sequences,and horizontal plane T2WI sequences.Some cases received enhanced scan lines,with the Magen Wei contrast agent（Gd-DTPA） injection,0.1 mmol/kg intravenous injection.RESULTS Among the patients,two vertebrae were involved at the same time in 19 cases,accounting for 54.3%.Involvements of more than 2 vertebrae were observed in 14 cases,accounting for 40.0%.There were only 2 cases where one vertebral body was involved.There were 86 vertebrae in total.The involved sites were as the followiy：15 cervical vertebra,19 thoracic vertebra,11 lower thoracic vertebra,38 lumbar vertebra,and 3 sacral vertebra.CT findings of all patients with vertebral disc damage,paraspinal mass or abscess,epidural and/or foramen violation,ligament spread,and enhancement and calcification of meninges were observed in 35,30,5,1,1 and 25 cases,respectively.Compared with CT,the MRI findings were observed in 35,30,15,20,16,and 2 cases,respectively.CONCLUSION CT and MRI manifestations for the spinal tuberculosis in elderly patients have their own characteristics.The clinical comprehensive analysis of CT and MRI manifestations of spinal tuberculosis is of great importance to the diagnosis,differential diagnosis and treatment.