布氏杆菌脊柱炎与脊柱结核的影像学比较

Comparison of Imaging features between brucellitis spondylitis and tuberculous spondylitis

目的比较分析布氏杆菌性脊柱炎与结核性脊柱炎的影像学差别,尤其是CT及MRI的不同表现,为临床提供参考。方法选取我院确诊的布氏杆菌性脊柱炎患者26例和确诊的脊柱结核患者33例作为观察对象,均采用X/CT/MRI进行检查对比两组患者的影像学表现的差异,结合PPD及布式杆菌血清学检查进行比较。结果两组患者,X/CT均可见椎体破坏、椎间隙狭窄,椎旁脓肿改变。布氏杆菌脊柱炎患者可见椎体破坏更靠近终板,椎间隙狭窄或消失,椎旁脓肿有12/26例(46.1%),死骨有5/26例(19.2%),椎管内硬膜外脓肿有7/26例(26.9%)出现,脓肿量少,有2例出现下肢运动感觉降低。MRI布式杆菌脊柱炎的椎旁脓肿影内可见多个类圆形如“豌豆样”的中等信号影组织。而脊柱结核的椎体破坏重,椎间隙狭窄较轻,椎旁寒性脓肿多,可形成明显的腰大肌脓肿有29/33例(87.9%),多可流注到腹膜后或椎管内,明显压迫硬脊膜,有21/33例(63.6%)脓肿内可见坏死的沙砾样死骨或大块死骨,椎管内硬膜外脓肿25/33例(78.1%)出现,椎管内脓肿量大,有6例出现下肢运动感觉明显降低,2例出现受压瘫痪。结论布氏杆菌脊柱炎和脊柱结核患者在CT/MRI椎间盘异常信号、椎体形态、椎间隙狭窄、椎旁/硬膜外脓肿情况差异明显不同,布式杆菌的椎旁脓肿小,死骨少,尤其是在MRI上,布式杆菌脊柱炎可见到多个类圆形如“豌豆样”的中等信号影,因此均可作为两种疾病的鉴别诊断指标之一,提升诊断的准确率。

Objective To compare and analyze the differences of imaging features between brucella spondylitis and tuberculous spondylitis,especially the different manifestations of CT and MRI,and provide reference for clinical.Methods Twenty-six patients with brucellitis spondylitis diagnosed in our hospital from March 2007 to November 2017,and 33 patients with spinal tuberculosis diagnosed from February 2010 to April 2019 were selected as subjects.The imaging findings of X/CT/MRI were compared and analyzed between the two groups.And the PPD and Brucella serological test were compared.Results There was no significant difference in the mean age and sex ratio between the two groups.In both groups,from X/CT we could see vertebral destruction,the narrow intervertebral space,paravertebral abscesses,or psoas abscess.However,in patients with brucellosis spondylitis,the part of damaged vertebral body was closer to the endplate,and the narrow or disappearance of the intervertebral space was more significant.Twelve patients(12/26,46.1%)had paravertebral abscesses.There were 5/26(19.2%)cases of necrotic bone.The intraspinal epidural abscess was seen in 7/26(26.9%)cases,the amount of abscess was small.And 2 patients showed lower motor sensation.The vertebral body damage of spinal tuberculosis was more serious,the intervertebral space was narrow,and there were 29/33 patients(87.9%)with obvious paravertebral cold abscesses,which could be flew into the retroperitoneum or back muscle space.In the spinal canal,the dura mater was obviously pressed.And some necrotic sand-like bone,massive necrotic bone,or collapsed vertebral body could be seen in some abscesses or veterbral in 21/33 cases(63.6%).There were 25/33 patients(78.1%)had intraspinal epidural abscess.The lower limb movement and sensation was reduced in 6 cases,and the lower limbs were paralysis in 2 patients.On MRI,the rate of abscess was similar to that of CT.In both groups,the affected vertebral body and paravertebral abscess with long T1,long T2 or mixed T2 signal were observed.Some of the dural sac or spinal cord were pressed by the abscesses,resulting in lower limbs to obstacle or disability.And the patients with infection with Bacillus had obvious narrow of the intervertebral space,less paravertebral abscess,abscess does not exceed the diseased vertebral body.In patients with brucellosis spondylitis,there were many round"pea-like"images,medium signal shadow tissue,in the paravertebral abscess.While the amount of visible paravertebral abscess in spinal tuberculosis was large,mostly exceeds the lower edge of the diseased vertebral body,and no"pea-like"medium signal was seen.Conclusion Brucella spondylitis and spinal tuberculosis patients have significant differences in disc abnormalities,vertebral morphology,intervertebral space narrow,paravertebral/epidural abscess on CT/MRI.On MRI,a variety of circular"pea-like"medium signal features can be seen in Brucella spondylitis patients.It can be used as one of the differential diagnosis indicators of the two diseases,to improve the accuracy of diagnosis.