慢性布氏菌性脊柱炎影像学表现及鉴别诊断

Imaging findings and differential diagnosis of chronic brucellosis spondylitis

目的探讨慢性布氏菌性脊柱炎的影像学征象,提高该病的影像学诊断及鉴别诊断。方法回顾性分析65例经临床确诊慢性布氏菌性脊柱炎患者的影像资料,65例均进行DR检查,其中50例进行CT检查;42例行MRI检查,对其特异性影像学征象进行总结、分析。结果 DR可显示慢性布氏菌性脊柱炎椎体终板缘骨质破坏同时伴有明显的骨质增生、硬化,相邻椎间隙狭窄,未见椎旁及腰大肌脓肿,多椎体发病呈跳跃性发病为其特征性表现;CT除显示DR的表现外,可显示较早期的微小骨质破坏;MRI在病变早期就可显示椎体、椎间盘及周围软组织内的异常信号,并可显示微量椎旁及腰大肌脓肿,且增强扫描可显示椎旁条状及环状强化,但对骨质增生硬化显示不敏感。结论提高对慢性布氏菌性脊柱炎的特异性影像学征象的认识,结合患者的生活史、工作史以及相关实验室检查,对慢性布氏菌性脊柱炎的诊断及鉴别诊断具有重要的价值。

Objective To explore the specific imaging features of chronic brucellosis spondylitis and to improve the ability to diagnose and differential diagnose of the disease. Methods We retrospectively analyzed the images of 65 patients with clinically diagnosed chronic brucellosis spondylitis, and summarized their specific imaging findings. All 65 cases were examined by DR, and 50 cases by CT, 42 cases by MRI. Results DR can show the bone destruction of vertebral endplate at the same time with obvious hyperosteogeny, adjacent intervertebral space stenosis, no paraspinal and psoas abscess, multiple vertebral body disease showing the jumping characteristic; In addition to showing the finding of DR, CT can show the early micro-bone destruction; In the early lesions, MRI can show the vertebral body, intervertebral disc and surrounding soft tissue abnormal signals, and can dis- play micro-paraspinal and psoas abscess, and paravertebral strip and ring enhancement in enhanced scan, but it is not sensitive to hyperosteogeny. Conclusion It is very valuable for the diagnosis and differential diagnosis of chronic brucellosis spondylitis by improving the recognition of the specific imaging features of it and by combining with the patient ＇s life history, work history and re- lated laboratory tests.