四肢关节结核的CT及MRI表现

CT and MR Imaging Features of Joint Tuberculosis of the Appendicular Skeleton

目的:探讨外周大关节结核的CT、MRI表现及其鉴别诊断。方法:分析19例经病理证实或抗结核治疗效果显著的大关节结核的临床资料、CT和(或)MRI检查结果。结果:19例患者中,肘关节2例,踝关节3例,髋关节4例,肩关节4例,膝关节5例,腕关节1例。10例患者同时发现肺内结核,1例合并结核性胸膜炎,另外1例同时合并肺结核及脑内结核。关节结核的主要CT表现包括病灶周围的骨质疏松、关节面下骨质破坏、关节滑膜增生和进行性关节间隙狭窄。MRI则易发现关节软骨及关节面下骨质破坏,关节滑膜增生,骨髓水肿,冷脓肿形成。增强扫描增生的关节滑膜及冷脓肿壁显著强化。结论:大关节结核的CT或MRI表现具有一定的特征性。结合临床病史,CT及MRI检查结果,有助于做出早期准确的诊断。

Objective:To investigate the CT and MRI manifestations of tuberculosis in peripheral large joints and to discuss the differentiation with other diseases.Methods:The present study retrospectively examined 19 patients with tuberculosis in large joints,pathologically confirmed or cured with anti-TB treatment,and analyzed the clinical presentations and imaging findings to explore the imaging features of tuberculous arthritis.Results:There were 2 cases located in elbow joint,3 in ankle joint,4 in hip joint,4 in shoulder joint and 5 cases in knee joint and there was another case located in wrist joint.Eleven patients had a total of 13 additional sites of involvement:chest in 10,thorax in 1,lung as well as the central nervous system in one patient.CT revealed osteoporosis,bone destruction around the TB lesion in the joint,proliferative response of the synovial membrane and progressive joint space narrowing.MRI showed destruction of cartilaginous and osseous structures,proliferative changes in the synovial membrane,edema of the bone marrow,as well as periarticular abscesses.Contrast-enhancement scanning revealed obvious enhancement of proliferative synovial membrane and abscess wall around the lesions.Conclusion:There are certain imaging features that help to differentiate tuberculosis from other joint disorders with a similar presentation.Comprehensive analysis of clinical history,CT and MRI findings help to reach an early and correct diagnosis.