脊柱结核与脊柱转移瘤的多排螺旋CT鉴别诊断

Differential Diagnosis of Spinal Tuberculosis and Spinal Metastases by Multi - slice Spiral CT

目的分析脊柱转移瘤和脊柱结核的CT表现,探讨二者的CT鉴别诊断。方法回顾性分析我院2005～2011年经手术、病理及临床证实的脊柱结核与转移瘤40例,观察椎体、附件骨、椎间盘破坏方式,椎旁、椎管内脓肿的范围及脊髓受压情况,分析两组患者的CT影像学表现。结果 26例脊柱结核CT表现为骨质破坏、高密度死骨形成、椎体压缩、椎间盘破坏、椎旁、腰大肌脓肿、或椎管狭窄等症状;14例脊柱转移瘤征象是椎骨骨质破坏、增生或两者并存;以溶骨性破坏多见,常伴有椎旁软组织肿块形成,椎体引起压缩。结论多层螺旋CT能对脊柱转移瘤和脊柱结核的诊断及鉴别诊断提供帮助。

Objective To discuss the differential diagnosis of spinal tuberculosis and spinal metastases by analyzing their CT manifestation. Methods A retrospective analysis was made to 26 cases with spinal tuberculosis and 14 cases with spinal metastases, all confirmed by operation, pathological study and clinical features from 2005 to 2011 ; the fail- ure mode of vertebral body, appendixes bones and disc, the scale of paravertebral abscess and intraspinal abscess and the spinal cord compression were observed ; the CT image features of the patients in both groups were analyzed. Results The CT manifestations of the 26 cases with tuberculosis included bone destruction, high density sequestrum, verte- bral compression, disc failure, paravertebral and psoas abscess or spinal stenosis while those of the 14 cases with me- tastases included bone destruction of vertebra, hyperplasia, or the two together, most often osteolysis and erosion com- bined with abscess of pravertebral soft tissue and spinal compression. Conclusions Multi - slice spiral CT is helpful in the diagnosis and differential diagnosis of spinal tuberculosis and spinal metastases.