MRI联合血清CEA、FER检测在胸腰椎体结核感染诊断中的应用

Application of MRI combined with serum detection of CEA and FER in the diagnosis of thoracolumbar vertebral tuberculosis infection

目的分析磁共振成像(Magnetic resonance imaging,MRI)联合血清癌胚抗原(Carcinoembryonic antigen,CEA)、铁蛋白(Ferritin,FER)检测诊断胸腰椎体结核感染的临床价值。方法收集2018年1月-2019年1月西南医科大学附属医院收治的98例疑诊脊柱结核感染患者的临床资料,入院后均行MRI及血清CEA、FER检测,比较三者单独及其联合诊断胸腰椎结核感染的价值。结果 71例脊柱结核时间-信号曲线:持续增强型31例占43.66%,平台型39例占54.93%,速降型1例占1.41%;27例脊柱转移瘤时间-信号曲线:速降型16例占59.26%,平台型8例占29.63%,持续增强型3例占11.11%。脊柱结核、脊柱转移瘤信号曲线分级比较差异有统计学意义(P<0.05);脊柱转移瘤Ktrans、Vp、Kep高于脊柱结核患者,Ve低于脊柱结核(P<0.05);脊柱结核患者血清CEA、FER水平均低于脊柱转移瘤患者(P<0.05);单独监测中,CEA诊断脊柱结核效能最高,cut-off值≤45.66μg/L时诊断脊柱结核敏感度、特异性分别为100.00%、92.59%;三者联合诊断脊柱结核敏感度、特异性优于单独诊断,分别为97.18%、100.00%。结论 MRI联合血清学CEA、FER筛查可检出常规MRI无法检出脊柱结核感染,对鉴别脊柱结核感染与脊柱转移瘤有积极的价值。

OBJECTIVE To analyze the clinical value of magnetic resonance imaging(MRI) combined with detection of serum carcinoembryonic antigen(CEA) and ferritin(FER) in the diagnosis of thoracolumbar vertebral tuberculosis infection. METHODS The clinical data of 98 patients with suspected spinal tuberculosis infection who were admitted to the Affiliated Hospital of Southwest Medical University from Jan. 2018 to Jan. 2019 were collected. All patients underwent MRI and their serum levels of CEA and FER were detected. The value of the three alone and combined diagnosis of thoracolumbar tuberculosis infection was compared. RESULTS The spinal tuberculosis time-signal curve of 71 cases showed 31 cases(43.66%) of continuous en-hancement type, 39 cases(54.93%) of platform type, and 1 case(1.41%) of rapid decline type. The spinal metastasis time-signal curve of 27 cases showed 16 cases(59.26%) of rapid decline type, 8 cases(29.63%) of platform type, and 3 cases(11.11%) of continuous enhancement type. There were significant differences in grades of signal curves between spinal tuberculosis and spinal metastases(P<0.05). The Ktrans, Vp and Kep in patients with spinal metastases were significantly higher than that with spinal tuberculosis, and Ve was significantly lower than spinal tuberculosis(P<0.05). Serum levels of CEA and FER in patients with spinal tuberculosis were significantly lower than that in patients with spinal metastases(P<0.05). When single indicator was used in the diagnosis of spinal tuberculosis, the efficiency of serum CEA detection was the highest. The sensitivity and specificity for diagnosis of spinal tuberculosis were 100.00% and 92.59%, respectively as the cut-off value was lower than 45.66 μg/L. The sensitivity and specificity of the three combined diagnosis in spinal tuberculosis(97.18% and 100.00%) were higher than that of single indicator. CONCLUSION MRI combined with serological CEA and FER detection can discover spinal tuberculosis infection which can not be detected by conventional MRI, which had the positive value in the identification of spinal tuberculosis infection and spinal me-tastases.