核磁共振对布鲁菌性脊柱炎与结核性脊柱炎的鉴别价值

The value of MRI in differentiating Brucella spondylitis from tuberculosis spondylitis

目的分析布鲁菌性脊柱炎与结核性脊柱炎的核磁共振(MRI)征象,探讨MRI在布鲁菌性脊柱炎与结核性脊柱炎鉴别诊断中的价值。方法采用回顾性分析方法,纳入2015年1月至2017年12月在新疆医科大学第一附属医院行MRI检查布鲁菌性脊柱炎与结核性脊柱炎的患者,收集的所有患者MRI检查均有T1WI、T2WI及STIR图像,比较分析两组患者病变部位、MRI信号、椎体破坏、椎体楔形变、后突畸形、附件破坏、有死骨、骨质增生、椎间隙改变、脓肿部位、脓肿范围的差异。结果共纳入布鲁菌性脊柱炎患者91例,其中女性36例,男性55例,平均年龄49.40岁;纳入同期检查的结核性脊柱炎患者112例,其中女性48例,男性64例,平均年龄47.15岁。两组患者性别、年龄比较差异无统计学意义(χ2=0.225,t=1.387,P均>0.05)。布鲁菌性脊柱炎好发于腰椎[72.53%(66/91)],结核性脊柱炎好发于胸椎[47.32%(53/112)]。布鲁菌性脊柱炎患者在T2WI高信号表现高于结核性脊柱炎患者[51.65%(47/91)比24.11%(27/112),P<0.05];在T2压脂高信号表现低于结核性脊柱炎患者[59.34%(54/91)比72.32%(81/112),P<0.05];在椎体轻度破坏、骨质增生、椎间隙正常、椎旁脓肿、脓肿范围未超出病变椎体征象的发生率高于结核性脊柱炎患者[81.32%(74/91)、93.41%(85/91)、37.36%(34/91)、71.43%(65/91)、38.46%(35/91)比20.54%(23/112)、28.57%(32/112)、1.79%(2/112)、30.36%(34/112)、1.79%(2/112),P均<0.01];在椎体重度破坏、椎体楔形变≤1/2、后突畸形、有死骨、椎间隙变窄、椎间隙消失、腰大肌脓肿、脓肿范围超出病变椎体征象的发生率低于结核性脊柱炎患者[12.09%(11/91)、18.68%(17/91)、2.20%(2/91)、2.20%(2/91)、61.54%(56/91)、1.10%(1/91)、2.20%(2/91)、1.10%(1/91)比75.89%(85/112)、72.32%(81/112)、29.46%(33/112)、46.43%(52/112)、79.46%(89/112)、18.75%(21/112)、66.96%(75/112)、74.11%(83/112),P均<0.01]。结论MRI征象通过骨质增生、椎体破坏、椎体楔形变、后突畸形、有死骨、椎间隙异常,以及椎旁脓肿及腰大肌脓肿情况分析,可鉴别诊断布鲁菌性脊柱炎与结核性脊柱炎。

Objective To evaluate the value of magnetic resonance imaging(MRI)in differentiating Brucella spondylitis from tuberculosis spondylitis.Methods A retrospective analysis method was used to include Brucella spondylitis patients and tuberculous spondylitis patients who had undergone MRI examination at the First Affiliated Hospital of Xinjiang Medical University from January 2015 to December 2017.All patients data of MRI examination(all had T1WI,T2WI,STIR images)were collected and compared.The differences in lesion location,MRI signal,vertebral body destruction,vertebral wedge,kyphosis deformity,attachment destruction,dead bone,bone hyperplasia,intervertebral space change,abscess location,and abscess range were analyzed.Results A total of 91 patients with brucella spondylitis were selected,including 36 women and 55 men,with an average age of 49.40 years old;112 patients with tuberculous spondylitis selected in the same examination,including 48 women and 64 men,with an average age of 47.15 years old.There was no statistically significant difference in gender and age between the two groups(χ2=0.225,t=1.387,P>0.05).Brucella spondylitis was more common in lumbar spine[72.53%(66/91)],and tuberculosis spondylitis was more common in thoracic spine[47.32%(53/112)].Brucella spondylitis patients showed higher T2WI hyperintensity than tuberculosis spondylitis patients[51.65%(47/91)vs 24.11%(27/112),P<0.05];and showed lower T2 hyperlipidemia than patients with tuberculosis spondylitis[59.34%(54/91)vs 72.32%(81/112),P<0.05];the incidence rates of mild destruction of vertebral body,bone hyperplasia,normal intervertebral space,paravertebral abscess,and abscess not exceeding the range of vertebral body were higher than those of patients with tuberculosis spondylitis[81.32%(74/91),93.41%(85/91),37.36%(34/91),71.43%(65/91),38.46%(35/91)vs 20.54%(23/112),28.57%(32/112),1.79%(2/112),30.36%(34/112),1.79%(2/112),P<0.01];the incidence rates of vertebral body severe destruction,vertebral wedge less than 1/2,kyphosis deformity,dead bone,inter vertebral space narrowing,inter vertebral space vanishing,psoas abscess,abscess beyond the range of vertebral body were lower than those of patients with tuberculous spondylitis[12.09%(11/91),18.68%(17/91),2.20%(2/91),2.20%(2/91),61.54%(56/91),1.10%(1/91),2.20%(2/91),1.10%(1/91)vs 75.89%(85/112),72.32%(81/112),29.46%(33/112),46.43%(52/112),79.46%(89/112),18.75%(21/112),66.96%(75/112),74.11%(83/112),P<0.01].Conclusions MRI signs can be used to differentiate Brucella spondylitis from tuberculosis spondylitis through analysis of bone hyperplasia,vertebral body destruction,vertebral wedge,kyphosis deformity,dead bone,abnormal intervertebral space,and paravertebral abscess and psoas abscess.