骨感染性病变诊断中CT平扫联合三维重建技术的临床价值

Clinical value of CT scanning combined with three-dimensional reconstruction technique in diagnosis of bone infections

目的探讨骨感染性病变CT平扫及三维重建成像的特点,为提高CT在骨感染性病变诊断中的价值。方法回顾性调查2010年1月-2014年11月经手术病理或穿刺病理证实为骨感染性病变患者30例临床资料,分析治疗前CT平扫和三维重建图像的特点,采用GE Lightspeed 64层螺旋CT机扫定位像。结果 30例骨感染性病变患者中有13例为急性感染,占43.3%;感染患者检出病原菌分别为结核分枝杆菌、金黄色葡萄球菌、铜绿假单胞菌及布鲁氏杆菌,分别占53.4%、40.0%、3.3%、3.3%;30例骨感染性病变患者CT表现阳性有病骨周围出现软组织肿块、脓肿、骨质呈溶骨性破坏、病灶内出现明显死骨、边缘出现硬化、有明显骨膜反应、病灶内出现积气及VR成像后骨质出现明显缺损,阳性率分别为10.0%、60.0%、96.7%、70.0%、46.7%、36.7%、30.0%及43.3%。结论骨感染性的病变的CT典型表现为边界不清楚溶骨性的骨质破坏、可见明显死骨形成,不同致病菌所致的骨感染CT变现各具特点,各种类型骨感染性疾病的确诊需要结合病原学和病理学。

OBJECTIVE To explore the features of the CT and three-dimensional reconstruction images for the bone infections so as to improve the value of CT scanning in the diagnosis of bone infections.METHODS From Jan 2010 to Nov 2014,a total of 30 patients who were confirmed as the bone infections through surgical pathology and needle biopsy were enrolled in the study,the clinical data of the participants were retrospectively reviewed.The feature of the CT scanning and three-dimensional reconstruction images were observed before the treatment,and the positioned images were scanned with the use of GE Lightspeed 64-slice spiral CT machine.RESULTS Of 30 patients with bone infections,13 cases had acute infections,accounting for 43.3%.Mycobacterium tuberculosis,Staphylococcus aureus,Pseudomonas aeruginosa,and Brucella were the isolated pathogens causing the infections,accounting for 53.4%,40.0%,3.3%,and 3.3%,respectively.As for the CT findings of the 30 patients with bone infections,the positive rates of the soft tissue mass,abscess,osteolytic destruction,clear sequestrum in lesions,hardened edge,obvious periosteal reaction,pneumatosis in lesions,and obvious bone defects in VR image were 10.0%,60.0%,96.7%,70.0%,46.7%,36.7%,30.0%,and 43.3%,respectively.CONCLUSIONThe typical CT findings of the patients with bone infections include the osteolytic destruction with unclear boundary and obvious sequestrum formation.The CT findings vary in the patients with bone infections caused by different pathogens,and the bone infections need to be confirmed in combination with etiology and pathology.