布氏杆菌性脊柱炎的CT及MRI表现

CT and MR findings of Brucellosis spondylitis

目的:探讨布氏杆菌性脊柱炎的计算机断层扫描(CT)及磁共振成像(MRI)表现,以提高对该病影像诊断水平。方法:对27例经临床及实验室检查确诊为布氏杆菌性脊柱炎患者的CT、MRI资料进行回顾性分析。结果:27例中3例为单椎体病变(14. 2%),9例为相邻2个椎体病变(33. 3%),15例为3个椎体及以上病变(55. 5%)。共有69个椎体病变,其中腰2及以上椎体18个(26. 1%),腰3及以下椎体51个(73. 9%)。病变椎体影像学主要表现为骨质破坏,多呈多发的类圆形或不规则破坏区;早期骨质破坏从椎体上下边缘软骨终板面开始,骨质破坏区周围骨质增生不明显或见轻度硬化带;晚期骨质破坏从终板面逐渐向椎体内部侵犯,周边可见明显的增生硬化;病变椎体多数形态尚可。大部分病变椎体未见破坏灶累及附件,椎间隙出现不同程度的狭窄,椎间盘结构不均,多数椎旁形成脓肿。MRI在显示布氏杆菌性脊柱炎的早期骨髓炎性浸润、骨髓水肿以及椎间盘的破坏方面较CT清楚。结论:布氏杆菌性脊柱炎CT、MRI有一定的特征性,对布氏杆菌性脊柱炎有重要的诊断价值。

Objective: To explore the imaging manifestations of CT scan and MRI of Brucellosis spondylitis and to improve the imaging diagnosis of Brucellosis. Methods: CT and MRI data of 27 patients with Brucellosis spondylitis were retrospectively analyzed. Results: Among the 27 cases,there were 3 cases with single vertebral lesion( 14. 2%),9 cases with two adjacent vertebral body lesions( 33. 3%),and 15 cases with 3 or more vertebral bodies lesions( 55. 5%). There were total of 69 vertebral body lesions: L2 and above vertebrals were damaged in 18 ones( 26. 1%);L3 and below vertebrals were damaged in 51 ones( 73. 9%). The imaging manifestations of the lesion vertebral body were mainly round or irregular areas with multiple bone destruction;the early damage started from the upper and lower edge of vertebral body cartilage endplate surface,and the bone hyperplasia around the bone destruction areas was not obvious or was slightly sclerotic;at the late stage,the bone destruction invaded the vertebral body from the endplate surface gradually,and obvious hyperplasia and sclerosis were found around the vertebral body. Most vertebral bodies showed no lesion involving appendages;the intervertebral spaces had different degree narrow and the intervertebral disc structures were uneven;most paravertebral abscesses were formed. MRI was better than CT in showing bone marrow inflammatory infiltration and edema,as well as the destruction of interbertebral disc. Conclusion: The imaging manifestations of CT and MRI of Brucellosis spondylitis have certain characteristics,which have an important diagnostic value for the Brucellosis spondylitis.