布鲁氏菌性脊柱炎的影像学表现

Analysis of image manifestations of Brucellar spondylitis

目的 :探讨布鲁氏菌性脊柱炎的影像学表现特征,以提高对该病的认识水平。方法 :回顾性分析19例经病理或实验室检查确诊的布鲁氏菌性脊柱炎的影像学资料,均行DR检查,其中15例加行CT检查,17例加行MRI检查,12例加行SPECT-CT检查。结果 :19例中,腰椎受累占89.5%(17/19),以L4~5椎体发病率最高。19例DR显示椎体骨质密度增加,边缘骨质增生,相应椎间隙变窄,部分可见骨桥形成。CT显示15例均可见椎体边缘斑片状、类圆形或"刀锯样"骨质破坏,周围骨质增生硬化;7例见典型的"花边椎",3例累及椎小关节。MRI显示15例椎体边缘明显骨质破坏,呈均匀或不均匀的长T_1长T_2信号,脂肪抑制序列T_2WI呈不均匀高信号,破坏区见骨质增生硬化及骨髓水肿信号,椎间盘呈长T_1信号,椎间隙变窄,其中5例椎旁软组织内可见局限性的脓肿,无钙化及流注现象,脓肿呈长T_1长T_2信号,边界清晰,脓肿壁厚薄不均;2例椎体仅见骨髓水肿,未见明显骨质破坏。SPECT显示12例均可见病变椎体呈弥漫性放射性核素浓聚;SPECT-CT图像融合后显示椎体边缘骨质增生硬化,并可见破坏区显著的放射性核素浓聚,椎间盘轻度浓聚。结论:布鲁氏菌性脊柱炎的影像学表现具有一定的特征性,需结合病史、实验室检查及流行病学特征进行综合诊断,以提高其诊断准确率。

Objective：To investigate the imaging features of the Brucellar spondylitis,in order to improve the level of awareness and diagnosis rate of the disease. Methods：The imaging data of 19 patients diagnosed by pathology or laboratory examination were retrospectively analyzed,all patients underwent DR examination,15 cases underwent CT examination,17 cases underwent MRI examination,12 cases underwent SPECT/CT examination. Results：In 19 cases,the incidence of lumbar vertebrae was 89.5%（17/19）,and the highest involved were L4 and L5. DR showed the vertebral bone density increase,and bone hyperplasia in the margin of vertebral body,disc space narrowing,and partially visible bone bridge. CT showed that the bone destruction which was nearly-circular or saber was observed in 15 cases of vertebral edge,surrounding bone hyperplasia sclerosis,7 cases showed typical lace vertebral,and 3 cases involved the vertebral facet joint. MRI showed vertebral edge obvious bone destruction were detected in 15 cases with uniform or nonuniform long T_1 and long T_2 signal,and the fat suppression sequence T_2 WI was inhomogeneous high signal. Bone destruction was accompanied by marrow oedema and osteosclerosis. Intervertebral disc showed long T_1 signal and disc space became narrow. Paraspinal localized abscess which was long T_1 and long T_2 signal was formed in 5 cases,no calcification and streamer abscess phenomenon,and clearly boundary,abscess wall was uneven;2 cases showed marrow oedema only with no obvious bone destruction. SPECT showed that 12 cases showed diffuse radionuclide concentration in the diseased vertebral body. SPECT/CT fusion showed bone hyperplasia and sclerosis in the vertebral body edge and significant radionuclide concentration,and the intervertebral disc mild concentration. Conclusion：The image manifestations of Brucellar spondylitis have certain characteristics,which can be combined with the clinical diagnosis,laboratory examination and epidemiological features to improve the diagnostic rate.