老年性脊柱结核的影像学表现

The imaging manifestation in aged spinal tuberculosis

目的:探讨老年性脊柱结核的影像学表现。方法:回顾性分析经临床或病理证实的43例老年性脊柱结核的影像学资料。结果:43例患者共累计81个椎体受累,包括颈、胸、腰和骶椎各11、24、42和4个,其中累及单个椎体4例,2个椎体28例,2个以上椎体11例。X线检查35例发现病变,主要表现椎间隙狭窄,椎体骨质破坏或塌陷变扁,脊柱序列改变,其中准确诊断23例,7例误诊,5例漏诊。CT扫描24例均发现病变,主要表现为椎体骨质破坏,脓腔及死骨形成,椎旁软组织肿胀或脓肿,椎间盘破坏并间隙狭窄,准确诊断19例,误诊5例,2例漏诊。MRI检查18例均发现病变,主要表现椎体骨质破坏,呈稍长或长T1长T2信号,STIR呈明显高信号,椎旁软组织肿胀,或脓肿形成,椎管内硬膜囊及脊髓受压,椎间盘形态及信号改变,准确诊断16例,误诊2例。结论:老年性脊柱结核影像学表现具有一定特征性,但有时易与老年性脊柱退变、转移瘤等混淆,多种影像学检查相互结合与印证,有助于病变的全面观察和准确诊断。

Objective： To investigate the imaging fingdings in aged spinal tuberculosis. Methods： Imag-ing findings of 43 elderly patients with spinal tuberculosis proved pathologically or clinically were analyzed retrospectively. Results： Eighty-one vertebral bodies were affected in total, including 11, 24, 42 and 4 vertebral bodies separately in the cervical, thoracic, lumbar and sacrococcygeal spine. Four cases were limited to a single vertebral body, 28 cases occurred in two adjacent vertebrae, and 20 cases involved multiple vertebral bodies. The X-ray features of the 35 patients mainly included： disc-space narrowing, vertebral bodies destruction or wedged, and spinal sequence disordering. Twenty-three of them were confirmed exactly, 7 cases were misdiagnosed, and 5 patients＇ disease diagnoses were missed. The CT scan largely involved vertebral bodies destruction, abscess and sequestrum formation, paravertebral soft tissue swelling, intervertebral disc damaging and intervertebral space narrowing. Nineteen of them were proved accurately, 5 cases were misdiagnosed, and 2 patients diagnoses were missd. The major characteristics in MRI were vertebral body lesions （little low or low on T1W images, high on T2W images and visibly high on STIR）, paraspinal soR tissue swelling and abscess informed. Also the dural sacs and spinal cord were compressed, intervertebral signal and shape changed. Sixteen cases were diagnosed cor- rectly, 2 of them were misdiagnosed. Conclusion： The aged spinal tuberculosis which is difficult to distinguish from other diseases, e.g. spine degeneration, metastasis, is of special imaging characteristics. Imaging studies combining together are helpful to thoroughly observe and exactly diagnose the disease.