脊柱结核病理及影像学形态多样性特征

Multiform Character of Imaging and Pathological in Spinal Tuberculosis

目的探讨脊柱结核病理学、影像学改变的形态多样性特征,以提高脊柱结核诊断的符合率。方法 85例经手术、病理证实的脊柱结核,对其病理学变化和MRI、CT、X线影像学表现进行对照分析。结果影像学改变主要有骨质破坏、椎体水肿和椎间盘破坏、结核肉芽肿、椎旁脓肿、死骨,未液化干酪坏死,新骨增生及钙化,全部病例都有其中四种以上影像学改变。病理学改变主要有急、慢性炎性细胞渗出、纤维组织增生、干酪样坏死、结核结节、肉芽组织炎、骨细胞变性、坏死、郎汉氏巨细胞及钙化,97.6%病例可见其四种以上病理变化,病理和影像学表现为形态多样性。结论脊柱结核病理的形态多样性决定了影像学的形态多样性,病理、影像学的形态多样性特征是脊柱结核的重要特征,对脊柱结核的诊断、鉴别诊断及治疗具有重要意义。

Objective To investigate the morphological diversity of spinal tuberculosis pathologic and imaging changes characteristics, in order to improve the coincidence rate of diagnosis of spinal tuberculosis. Methods Comparison analysis of 85 cases pathologic change and MRI, CT, X-ray imaging featrurs of spinal tuberculosis were performed. All of the cases were confirmed by operation and pathology. Results The imaging changes mainly included bone destruction, edema of vertebral body and intervertebral disc, tuberculous granuloma, vertebral abscess, bone sequestration, unliquefied caseous necrosis, bone proliferation and calcification. All of the cases were more than the above four kind of imaging changes. Pathological changes mainly include acute and chronic inflammatory cells exudation, fibrous tissue hyperplasia, caseous necrosis, tuberculous nodules, granulation tissue inflammation, bone cell degeneration, necrosis. Langerhans giant cells and calcification. 97.6% cases had more than 4 kinds of pathological changes, pathology and the imaging findings of morphological diversity. Conclusion Characteristics of morphological diversity of spinal tuberculosis pathologic and imaging are the important characteristics of spinal tuberculosis. It is of great significance on the diagnosis, differential diagnosis and treatment in spinal tuberculosis.