非结核分枝杆菌骨感染的CT特征分析

CT characteristic of bone infection with non-tuberculosis mycobacteria

目的 探讨非结核分枝杆菌病骨感染的CT特征,提高非结核分枝杆菌骨感染的CT诊断水平。方法 回顾性收集广州市胸科医院2015年1月至2021年1月确诊的22例非结核分枝杆菌骨感染患者的临床资料及CT图像,分析其CT特点。结果 本组22例患者中骨质破坏累及部位较广,多部位、多节骨、跳跃性骨质破坏占59.09%(13/22)。16例中轴骨中斑片状溶骨性和混合性骨质破坏占93.75%(15/16),单纯结节状成骨骨质破坏1例。15例合并溶骨性骨质破坏中,边缘合并厚硬化环和混合硬化环占66.67%(10/15),薄硬化环占26.67%(4/15),无硬化环占6.66%(1/15)。中轴骨中累及3个及以上椎体者占75%(12/16),椎间隙变窄及椎体塌陷者各占6.25%(1/16),合并死骨及脓肿者各占18.75%(3/16);椎体附件受累者占31.25%(5/16)。12例四肢带骨中,溶骨性及混合性骨质破坏91.67%(11/12),结节状成骨性骨质破坏1例;11例合并溶骨性骨质破坏中,边缘合并厚及混合硬化环者占72.73%(8/11),薄硬化环占27.27%(3/11);四肢带骨中,合并脓肿33.33%(4/12),死骨16.67%(2/12)。5例长骨及7例关节骨质破坏中均呈溶骨性骨质破坏,合并薄硬化环分别为2例和6例,合并脓肿分别为3例和7例,后者3例累及关节间隙。非结核分枝杆菌骨感染发生不同部位时,在骨质破坏形态、边缘硬化环、脓肿及椎间隙/关节间隙受累情况差异有统计学意义(P <0.05)。结论 非结核分枝杆菌病骨感染骨质破坏累及范围较广、呈跳跃性改变,中轴骨及四肢带骨以溶骨性及混合性骨质破坏多见,边缘多合并厚及混合型硬化环,较少累及椎间盘/关节间隙,脓肿及死骨少见;关节以溶骨性小囊状骨质破坏多见,常合并薄硬化环、脓肿,累及关节间隙,具有一定的CT特征,为临床的早期诊断提供依据。

Objective to study the CT features of nontuberculous mycobacterial bone infection and to improve the CT diagnosis of nontuberculous mycobacterial bone infection.Methods The clinical data and CT images of 22 patients with nontuberculous mycobacterial bone infection in Guangzhou chest hospital from January 2015 to January 2021 were collected retrospectively,and analyzed the CT characteristics.Results In this group of 22patients,the bone destruction involved a wide range of sites,including multiple sites、multiple joints and jumping bone destruction,accounting for 59.09%(13/22).93.75%(15/16)of the 16 cases had osteolytic and mixed bone destruction,One case was Osteogenesis damage.In 15 cases of osteolytic destruction,66.67%(10/15)of bone margin combined with thick and mixed sclerosis ring,26.67%(4/15)of thin sclerosis ring,and 6.66%(1/15)of no sclerosis ring.Three or more vertebral bodies accounted for 75%(12/16)in axial bones.The cases of vertebral space narrowing and vertebral collapse accounted for 6.25%(1/16),the cases of dead bone and abscess accounted for 18.75%(3/16);Vertebral appendage was involved in 31.25%(5/16).Among the 12 cases with bone in extremities,91.67%(11/12)had osteolytic and mixed bone destruction,one case was Osteogenesis damage.In 11 cases of osteolytic destruction,72.73%(8/11)had bone edge combined with thick and mixed sclerosis ring,and 27.27%(3/11)had thin sclerosis ring;33.33%(4/12)with abscess,16.67%(2/12)with dead bone.5 cases of long bone and 7 cases of joint bone destruction were lytic bone destruction,2 cases and 6 cases with thin sclerotic ring,3 cases and 7 cases with abscess respectively,3 cases involved joint space in the latter.There were significant differences in bone destruction pattern,marginal sclerosis ring,abscess and intervertebral/articular space involvement in different sites of non-tuberculous mycobacterium bone infection(P<0.05).ConclusionThe bone infection of non-tuberculous mycobacterium disease involved a wide range of sites,with jumping bone destruction.Osteolytic and mixed bone destruction were more common in the axial bone and extremities,and the margins were more complicated with thick and mixed sclerosis rings,intervertebral discs were less involved,and abscesses and dead bone were rare.Small cystic osteolytic bone destruction was common in joints,often complicated with thin sclerosis ring,abscess,involving joint space.It has certain CT features,providing basis for early clinical diagnosis.