核磁共振在脊柱结核诊断中的临床价值

The Clinical Value of MRI in the Diagnosis of Spinal Tuberculosis

目的应用核磁共振(MRI)与数字平片(DR)比较,探讨两者对脊柱结核病的价值,以发现早期脊柱结核病,防止病变发展与致畸方法回顾性分析42例确诊为脊柱结核患者的MRI及DR的影像学表现,对MRI和DR影像学表现进行对比分析结果42例诊断为脊柱结核的患者,骨质破坏39例,椎间盘变化32例,椎间软组织改变38例,脊髓及硬膜囊受侵18例,脊柱畸形15例 MRI在诊断脊柱结核的各种病变存在明显优势,4例早期结核,DR仅显示为轻度骨质改变,3例韧带下型结核X线均未发现异常,MRI发现早期病变7例。和DR相比,在骨质破坏、椎间盘变化、椎旁脓肿、脊柱畸形、脊髓及硬膜囊受侵等方面诊断敏感性都优于DR检查,且经分析,差异有统计学意义(P<0. 05)结论脊柱结核DR与MRI影像学表现多样,DR诊断快、费用低,但是在骨质未有明显破坏前,容易漏诊:MRI在脊柱结核病诊断中敏感性高,能在没有临床结核病症状情况下发现病变,明确病变对周围的侵犯,指导外科治疗,值得在脊柱结核的诊断中推广使用。

Objective To compare the value of MRI and X-ray in the study of spinal tuberculosis in order to detect early spinal tuberculosis and prevent the development and teratogenesis. Methods MRI and DR findings of 42 patients with spinal tuberculosis were retrospectively analyzed. The MRI and DR findings were compared and analyzed. Results Spinal tuberculosis was diagnosed in 42 cases,bone destruction in 39 cases,intervertebral disc changes in 32 cases,intervertebral soft tissue changes in 38 cases,spinal cord and dural sac invasion in 18 cases,spinal deformity in 15 cases. MRI had obvious advantages in the diagnosis of various diseases of spinal tuberculosis: of the 4 cases of early tuberculosis,DR showed only mild bone changes,and of the 3 cases of ligament,DR could not found abnormalities,MRI found early lesions in 7 cases.Compared with DR,MRI diagnosis rate of bone destruction,intervertebral disc changes,paraspinal abscess,spinal deformity,spinal cord and dural sac invasion were higher than DR examination,and the difference was statistically significant( P <0. 05). Conclusion The DR and MRI findings of spinal tuberculosis are diverse. DR diagnosis is quick with low cost but it risks letting it go unnoticed before it is obviously damaged. With high sensitivity in the diagnosis of spinal tuberculosis,MRI is able to detect pathological changes in the absence of clinical symptoms of tuberculosis lesions,clear lesions on the surrounding violations and guide surgical treatment,it is thus worthy of clinical promotion in the diagnosis of spinal tuberculosis.