SPECT／CT显像对布鲁菌病脊柱炎的诊断价值

Diagnostic value of SPECT/CT imaging for Brucellosis Spondylitis

目的 总结布鲁菌病脊柱炎的SPECT/CT影像表现，探讨SPECT/CT诊断该病的价值。方法 回顾性分析2012年6月至2015年10月间28例（男14例、女14例，平均年龄46.4岁）经实验室及手术病理证实为布鲁菌病脊柱炎患者的SPECT/CT图像，分析该病患者全身骨显像及SPECT/CT显像的影像特征。以病理和血清学结果为＂金标准＂ ，计算显像的诊断效能，采用χ2检验分析数据。结果 布鲁菌病脊柱炎大部分76.7%（43/56）发生于腰椎，且以下段腰椎为主[72.1%（31/43）]。病变常呈多灶性分布，71.4%（20/28）表现为连续2个或2个以上椎体受累；其全身骨显像89.2%（50/56）表现为中度放射性浓聚，5.4%（3/56）表现为轻度放射性浓聚影，5.4%（3/56）表现为高度放射性浓聚影；58.9%（33/56）表现为椎体弥漫性放射性浓聚，32.1%（18/56）表现为椎体上下缘弥漫性放射性浓聚，椎体一侧局限性放射性浓聚仅见8.9%（5/56）。SPECT/CT显像：80.4%（45/56）受累椎体表现为椎体内及椎体边缘小灶性骨质破坏，边缘清楚；66.7%（30/45）骨质破坏灶边缘伴有椎体骨质增生，骨质破坏灶边缘见中度放射性浓聚影；椎间盘病变较轻，椎体脓肿较为少见[5.4%（3/56）]。SPECT/CT显像与全身骨显像对布鲁菌病脊柱炎的诊断准确性差异有统计学意义[67.8%（38/56）与96.2%（54/56）; χ2＝13.1, P〈0.05]。结论 SPECT/CT显像诊断布鲁菌病脊柱炎有一定价值，且诊断效能高于全身骨显像。

Objective To summarize the SPECT/CT manifestation of spondylitis caused by Brucells infection and to evaluate the diagnostic value.Methods From June 2012 to October 2015, a total of 28 patients （14 males, 14 females, average age 46.4 years） with Brucellosis spondylitis confirmed by laboratory test and pathology were included. The images of whole-body bone scan and SPECT/CT fusion imaging were retrospectively analyzed. According to the pathological and serologic test results, the diagnostic efficacy of imaging was calculated. χ2 test was used.Results Most of the Brucellosis spondylitis happened in the lumbar（76.7%, 43/56）, and the most common locations were L3, L4, L5 （72.1%, 31/43）. Two or more involved consecutive vertebra were found in 71.4%（20/28） of the patients. Moderate radioactive distribution was showed in 89.2%（ 50/56） of lesions, high radioactive distribution was showed in 5.4%（3/56） of lesions, and mild radioactive distribution was showed in the rest 3 lesions. Thirty-three lesions（58.9%, 33/56） had diffuse increased radioactivity uptake in the affected vertebra, and 32.1%（18/56） showed diffuse increased radioactivity at the superior and inferior margin of the vertebra; only 8.9%（5/56） of lesions were on one side of the vertebral bodies. The SPECT/CT results were as follows： （1） Bone destruction was showed in 80.4%（45/56） of lesions, and the edge of the lesion was clear. （2） For 66.7%（30/45） of lesions, bone hyperplasia was seen along with bone destruction and moderate radioactivity concentration on the edge of destruction area. （3） The damage of the intervertebral disc was mild, and the vertebral abscess was relatively rare （5.4%, 3/56）. The diagnostic accuracy of SPECT/CT was statistically higher than that of whole-body bone scan： 67.8%（38/56） vs 96.2%（54/56）; χ2=13.1, P〈0.05.Conclusion SPECT/CT imaging has a higher diagnostic efficiency than whole-body bone scan in Brucellosis spondylitis.