19例布鲁氏菌病的MRI诊断及特点分析

MRI diagnosis and characteristics analysis of 19 patients with brucellosis disease

目的分析布鲁氏菌病(以下简称布病)的MRI特点,提高对布病的认识及诊断水平。方法回顾性分析2014年5月至2018年8月首都医科大学附属北京佑安医院收治的19例布病患者的MRI及临床资料,对受累部位MRI的特点进行分析。结果脊柱受累最常见,共15例,1例同时累及骶髂关节。布鲁氏菌脊柱炎MRI特点:腰椎常见,多为相邻2个椎体受累,椎体形态均正常,异常信号多弥散分布,T1WI稍低或等低混杂信号,T2WI稍高或混杂信号,T2压脂序列均呈高信号,增强后明显强化;骨质破坏均较轻,多发生在椎体相邻面,呈虫蚀样,周围可见骨髓水肿及骨质硬化,椎体边缘可见骨质增生;椎间隙多为轻度狭窄或正常;椎间盘可有炎性改变,于T2WI及T2压脂像椎间盘髓核中央有平行于终板的条形高信号,即椎间盘内炎性反应线;椎旁软组织不同程度增厚、肿胀或脓肿形成,均局限于上下相邻椎体水平,没有流注现象,少数伴有硬膜外脓肿;单骶髂关节及髋关节发病各1例。布鲁氏菌关节炎MRI表现无特异性,主要为关节腔积液,关节间隙正常或稍变窄,关节内骨质破坏、滑膜增生及关节周围软组织肿胀;累及颅脑2例。中枢神经型布病MRI特点:脑膜炎最常见;2例均以脑膜炎起病,头颅MRI增强扫描显示脑膜增厚强化。结论 MRI表现具有一定特征性,且能够发现早期病变,明确感染部位、范围及严重程度,在布病的诊断中具有重要意义。

Objective To analyze the MRI characteristics of brucellosis, in order to improve its understanding and diagnosis. Methods A retrospectively analysis was made of the MRI features and clinical data of 19 patients with brucellosis admitted to Beijing Youan Hospital from May 2014 to August 2018. Results Spinal involvement was the most common, involving 15 cases and sacroiliac joint in one case. MRI features of brucella spondylitis included that lumbar vertebrae involved was common, two adjacent vertebral bodies involved was common. The morphology of the vertebral body showed normal, abnormal signals were more diffusely distributed, T1 WI showed slightly lower or equal, low mixed signal, T2 WI showed slightly higher or mixed signal, T2 fat suppression sequence showed high signal, and enhanced significantly. Bone destruction was relatively mild, mostly occured in the adjacent edge of the vertebral body, showing worm-like appearance, which was accompanied by marrow oedema and osteosclerosis, bone hyperplasia at the edge of the vertebral body could be seen. The intervertebral space was often slightly narrow or normal. The intervertebral disc might have an inflammatory change. In the center of the nucleus pulposus of the intervertebral disc of the T2 WI and T2 fat suppression sequence, there was a strip-shaped high signal parallel to the endplate, which was a typical intervertebral disc inflammatory response line. Different degrees of thickening, swelling or abscess formation in the paraspinal soft tissue were limited to the level of the upper and lower adjacent vertebral bodies, no flow phenomenon, and a few with epidural abscess. One case involved the ankle joint, and one case involved the hip joint. MRI of Brucella arthritis showed no specificity, mainly included joint cavity effusion, normal or slightly narrow joint space, bone destruction in the joint, synovial hyperplasia and soft tissue swelling around the joint. Two cases involved the brain. MRI features of central nervous brucellosis included that meningitis was the most common, meningitis was found in both cases, and the enhanced MRI scan showed meningeal thickening and enhancement. Conclusions MRI has certain characteristics, and it can detect early lesions, determine the site, extent and severity of infection, and is of great significance in the diagnosis of brucellosis.