MRI在布鲁氏杆菌性脊柱炎临床诊断中的应用

Application of MRI in Clinical Diagnosis of Brucellosis Spondylitis

目的回顾性研究磁共振检查在布氏杆菌脊柱炎临床诊断中的应用价值。方法收集27例经临床确诊的布氏杆菌性脊柱炎患者的MRI资料并综合临床资料进行回顾性分析,对脊柱病变部位及周围组织影像学特点进行分析。结果布氏杆菌脊柱炎腰椎受累最多见,占85.2%(23/27),感染多呈连续性分布占81.5%(22/27),病变椎体形态常无明显改变占92.6%(25/27)。急性期,病变椎体、终板显示T1WI低信号和T2WI高信号,增强扫描呈明显均匀强化;亚急性和慢性期,病变椎体、终板显示T1WI低信号、T2WI混杂信号,增强扫描呈不均匀强化。布氏杆菌破坏椎体并突破终板、骨皮质及后纵韧带向周围组织蔓延,椎间盘受累呈不同程度压缩变窄占81.5%(22/27),椎旁软组织受感染占59.3%(16/27),可形成脊柱旁脓肿占37.0%(10/27)及硬膜外脓肿占62.9%(17/27)。结论布氏杆菌脊柱炎病变的MRI表现具有一定的特征性;MRI检查在布氏杆菌脊柱炎的诊断中具有重要价值。

Objective To evaluate the application value of magnetic resonance imaging（ MRI） examination in the clinical diagnosis of brucellosis spondylitis through the retrospective study. Methods 27 patients with clinically diagnosed brucellosis spondylitis were collected for MRI data and retrospectively analysis was performed combined with clinical data,to analyze the pathological changes of the spine and the surrounding tissue imaging characteristics. Results Patients with brucellosis spondylitis were often seen lumbar involvement（ 23 /27,85. 2%）. Most of the infections were distributed continuously（ 22 /27,81. 5%）. And the diseased vertebrae showed no obvious change in shape（ 25 /27,92. 6%）. In acute stage,diseased vertebrae and endplate showed low T1 WI and high T2 WI signal,and enhanced scan showed clear and uniform enhancement. In subacute and chronic phase,diseased vertebrae and endplate showed low T1 WI and mixed signal in T2 WI,and enhanced scan showed nonuniform enhancement. Brucella destroyed the vertebrae and broke through the endplate,bone cortex and posterior longitudinal ligament spreading to the surrounding tissues,with different degrees of compression and narrowing of intervertebral disc（ 22 /27,81. 5%）,infected paravertebral soft tissue（ 16 /27,59. 3%）,paravertebral abscess（ 10 /27,37. 0%） and epidural abscess（ 17 /27,62. 9%）. Conclusion MRI of brucellosis spondylitis shows certain characteristics; MRI examination has an important value in diagnosis of brucellosis spondylitis.