布鲁菌病脊柱炎与脊柱结核的CT及MRI鉴别诊断

Differential diagnosis between spinal brucellosis and spinal tuberculosis using CT and MRI

目的:探讨布鲁菌病脊柱炎与脊柱结核的CT、MRI表现,以提高二者鉴别诊断水平。方法:回顾性分析28例布鲁菌病脊柱炎和46例脊柱结核患者的CT、MRI表现。结果:布鲁菌病脊柱炎L4受累最多(16/28),骨质破坏轻,常伴增生、硬化(24/28),无脊柱畸形,椎旁脓肿小而多发(11/16),硬膜外脓肿常与椎间盘炎症病变相连(4/6);脊柱结核L1-2受累最多(14/46),骨质破坏明显,CT常见死骨(23/26),椎间隙变窄(40/46)明显,脊柱畸形多见(15/46),CT常见椎旁脓肿钙化(9/26),腰大肌脓肿常向下灌注(15/22)。结论:布鲁菌病脊柱炎与脊柱结核的CT、MRI表现有一定特征,但需结合病史及实验室检查方可及时作出鉴别诊断。

Objective：To explore CT and MRI manifestations of spinal brucellosis and spinal tuberculosis and discuss their differential diagnosis. Methods：CT and MRI features of 28 cases of spinal brucellosis and 46 cases of spinal tuberculosis were analyzed retrospectively. All the 28 cases of spinal brucellosis were confirmed by serological test with titers equal to or greater than 1/160 and/or positive blood culture. 17 were males and 11 were females; their average age was 52.7y （ranging from 25y to 65y）. CT examination was performed in 15 cases and MRI examination in 13 cases. （）f the 46 cases of spi nal tuberculosis,38 cases were confirmed by postoperative histopathology,and 8 cases by a combination of laboratory test, tuberculosis in other sites and follow up after antituberculotic therapy. 37 were males and 9 were females;their average age was 45.6y （ranging from 14y to 79y）. CT examination was performed in 26 cases and MRI examination in 20 cases. Results： Spinal brucellosis mainly affected the lumber spine,mostly the L4 （16/28）. Bone destruction mainly involved the end plate of vertebra and was often accompanied by sclerosis and osteophyte （24/28）, and often without kyphosis. Intervertebral space was often narrowed,with inhomogeneous disc signal. Paravertebral abscess was often small and multiple （11/16）, and epidural abscess was often connected with long T2 signal in discs （4/6）. Spinal tuberculosis mainly affected waist area and par ticularly L~ 2 （14/46）. Bone destruction was more obvious than that in spinal brucellosis and was often accompanied by se- questrum （23/26） on CT images. Kyphosis （15/46） was more often and abscesses were larger and often accompanied by calcifications （9/26） on CT images, and psoas abscess often spread downwards through several vertebral levels （15/22）. Conclusion：Both spinal brucellosis and spinal tuberculosis had some imaging features, but only with the help of history and laboratory examinations can they be differentiated from each other.