MRI及病理学鉴别早期化脓性脊柱炎及布氏杆菌脊柱炎中的应用及价值

MRI and pathological discrimination of early pyogenic spondylitis from brucella spondylitis

背景:病理学检测及MRI已在临床广泛应用,但将两者结合用于脊柱炎症早期鉴别诊断的研究较少。目的:通过观察病理与MRI征象改变,探讨病理学及MRI在早期化脓性脊柱炎与布氏杆菌脊柱炎鉴别诊断中的价值。方法:对22例化脓性脊柱炎及20例布氏杆菌脊柱炎患者行CT引导下经皮穿刺椎体活检及MRI检查,病理学切片观察结果包括病变骨组织结构及活力,组织细胞及其主要成分;MRI观察结果包括病变部位信号改变及征象变化。比较分析2组患者病理及MRI检查结果的构成比,统计方法为卡方检验。结果与结论:下列结果中,化脓性脊柱炎组发生率高于布氏杆菌脊柱炎组,且差异有显著性意义(P<0.05):嗜中性粒细胞浸润为主;椎间盘明显异常信号,椎体病变位置椎体前+后方,病变椎体形态明显变化,椎旁软组织异常信号,骨内或椎旁脓肿形成。提示病理学及MRI在早期化脓性脊柱炎与布氏杆菌脊柱炎的鉴别诊断中具有较高价值。

BACKGROUND： Pathological examination and MRI have been widely used in clinic, but their combination is rarely reported in discrimination of early spine infections. OBJECTIVE： To determine the accuracy of pathology and MRI for discrimination between early pyogenic spondylitis and brucella spondylitis. METHODS： Twenty-two patients with pyogenic spondylitis and 20 patients with brucella spondylitis who had CT-guided percutaneous biopsy and MRI of the spine were retrospectively reviewed. Pathological observations included structure and activity of bone lesions, tissue cells and their main components; MRI observations included signal and sign changes at lesion sites. Statistical analysis was performed with the chi-square test. RESULTS AND CONCLUSION： The patients with pyogenic spondylitis had a significantly higher incidence of pathological and MRI findings as follows （P 〈 0.05）： neutrophil infiltration; intervertebral disc abnormal signal, location of vertebral body lesions anterior＋posterior, obviously shape change in the vertebral body, paraspinal abnormal signal, presence of intraosseous or paraspinal abscess. Pathological and MRI examination was accurate for early differentiation of pyogenic spondylitis from brucella spondylitis.