193例脊椎结核的MRI表现分析

MRI features of spinal tuberculosis：a study of 193 cases

目的 分析脊柱结核的各种MRI表现特点，探讨MRI的诊断价值，以提高对该病的诊断水平。 方法 回顾性分析2009年9月至2013年5月在首都医科大学附属北京胸科医院行MRI检查，并经组织病理学或细菌学证实的脊柱结核患者193例，男113例，女80例，年龄范围5～87岁，平均（47±15.1）岁。分析患者病变部位与数目，观察患者椎体形态、椎间盘、椎旁脓肿、硬膜囊及脊髓受压等变化的MRI征象。 结果 193例脊柱结核患者，共525个椎体受累，其中单独累及腰椎者所占比例最高，为95例（49.2%，95/193），单独累及胸椎者54例（28.0%，54/193）；胸腰椎及腰骶椎同时受累者各13例（均占6.7%，13/193），单独累及颈椎者8例（4.1%，8/193），颈胸椎同时受累者4例（2.1%，4/193），单独累及骶椎者、胸腰骶椎和颈腰椎同时受累者各2例（均占1.0%，2/193）。每例患者累及椎体个数为1～9个，其中2个椎体受累患者最多见，共114例（59.1%，114/193）。MRI征象中，椎体形态改变者189例（97.9%，189/193），椎间盘受累172例（89.1%，172/193），182例（94.3%，182/193）可见椎旁脓肿影，硬膜囊及脊髓受压138例（71.5%，138/193），7例（3.6%，7/193）于T2WI可见脊髓异常高信号。 结论 MRI可清楚显示脊椎结核的椎体破坏、椎间盘信号的改变及椎旁脓肿范围，同时能明确硬膜囊受压情况和脊髓受累范围，对临床诊断和指导治疗有重要意义。

Objective To analyze the MRI features of 193 patients with spinal tuberculosis,and to investigate the role of MRI in spinal tuberculosis. Methods One hundred and ninety-three patients diagnosed spinal tuberculosis by histopathology or bacteriology examination were admitted to Beijing Chest Hospital affiliated to Capital Medical University from September 2009 to May 2013 （male：113,female：80;age：5-87 years old,average age（47±15.1）years old）. The following parameters were assessed by MRI： the presence of vertebral body involvement, discs involvement,paravertebral abscess and displacement of the dural sac and spinal cord. Results Accor-ding to MRI images,a total of 525 vertebrae involvement were involved in the 193 patients,lumbar vertebrae involved alone（49.2%,95/193）was the most common,followed by the thoracic vertebrae involved alone（28.0%,54/193）, thoracolumbar vertebrae and lumbosacral vertebrae involved were seen in 13 cases each（6.7%,13/193;6.7%,13/193）,cervical vertebrae involved in 8 cases（4.1%,8/193）and cervico thoracic vertebrae was involved in 4 cases（2.1%,4/193）;the range of lesion vertebrae was from 1 to 9, 2 vertebrae involved was seen in 114 cases（59.1%）. Analysis of MRI findings in 189 cases（97.9%,189/193） showed vertebral body deformation,and disc destruction was shown in 172 cases（89.1%,172/193） paravertebral abscess was noted in 182 cases（94.3%,182/193）. Dural sac and spinal cord compression were present in 138 cases（71.5%,138/193）,and 7 cases（3.6%,7/193）showed high signal intensity in the spinal cord on T2WI. Conclusion MRI images could detect several features of spinal tuberculosis including destruction of vertebrae,signal changes of intervertebral disc and the scope of paravertebral abscess.Meanwhile,it can show the compression of dural sac and displacement of spinal cord.It is of important value in diagnosis and treatment of spinal tuberculosis.