磁共振成像在布鲁氏菌性脊柱炎与脊柱结核的鉴别诊断价值

The value of magnetic resonance imaging in the differential diagnosis of brucellosis spondylitis and spinal tuberculosis

目的 探讨磁共振成像(MRI)在布鲁氏菌性脊柱炎与脊柱结核鉴别诊断中的应用价值,为布鲁氏菌性脊柱炎与脊柱结核的鉴别诊断提供参考依据。方法 选取广州市胸科医院及中山大学第一附属医院惠亚医院2019年1月到2021年12月期间收治的87例确诊脊柱结核患者作为脊柱结核组(广州市胸科医院87例),23例确诊布鲁氏菌性脊柱炎患者作为脊柱炎组(广州市胸科医院5例,中山大学第一附属医院惠亚医院18例),所有患者均行MRI检查,根据影像学资料比较两组的发病部位、椎体受累数、受累椎体信号形态特征、椎体破坏、椎间盘狭窄情况和脓肿信号。结果 两组的发病部位、椎体受累数对比无显著差异(P>0.05)。两组受累椎体信号形态特征对比差异有统计学意义(P <0.05),其中脊柱炎组的弥散型信号比例(50.00%)低于脊柱结核组(88.89%),局灶型比例(30.43%)高于脊柱结核组(11.11%),扇形信号比例(23.08%)高于脊柱结核组(0)。两组椎体破坏和椎间盘狭窄情况比较差异有统计学意义(P <0.05),其中脊柱炎组的椎体塌陷比例(0)低于脊柱结核组(43.52%),脊柱后凸畸形比例(3.85%)低于脊柱结核组(24.07%),椎间盘周围骨质破坏比例(46.15%)高于脊柱结核组(10.19%)。两组脓肿信号对比:脊柱结核组椎旁脓肿比例(54.02%)高于脊柱炎组(30.43%),脊柱结核组椎旁软组织异常信号比例(91.95%)高于脊柱炎组(52.17%),脊柱炎组韧带下脓肿≥3个椎体水平的比例(6.67%)低于脊柱结核组(57.75%),差异有统计学意义(P <0.05);脊柱炎组硬膜外脓肿比例(47.83%)、硬膜外脓肿伴神经症状比例(34.78%)、前纵韧带下脓肿比例(65.22%)与脊柱结核组比较无明显差异(P>0.05)。结论 布鲁氏菌性脊柱炎与脊柱结核患者在MRI检查中的骨质破坏程度、椎体信号形态、椎旁脓肿、椎旁软组织异常信号、脓肿扩散程度上具有明显差异,可为临床医师鉴别两种疾病提供重要的参考依据。

Objective To investigate the value of magnetic resonance imaging(MRI)in the differential diagnosis of brucellosis spondylitis and spinal tuberculosis,and to provide reference for the differential diagnosis of brucellosis spondylitis and spinal tuberculosis.Method To select the records of 87 patients with spinal tuberculosis in the Guangzhou Chest Hospital as spinal tuberculosis group,23 patients with brucellosis spondylitis as spondylitis group(Guangzhou Chest Hospital 5 cases,Huiya Hospital of The First Affiliated Hospital,Sun Yat-sen University 18 cases)from January 2019 to December 2021,all patients were performed MRI,according to the comparison of two groups of parts image information,the number of vertebral involvement,the affected vertebral signal morphological characteristics,destruction of vertebral bodies and intervertebral disc narrow and abscess.Result There was no significant difference in the incidence site and number of vertebral body involvement between the two groups(P>0.05).There was a significant difference in the signal morphology characteristics of the affected vertebral bodies between the two groups(P<0.05),among which the proportion of diffuse signals in the spondylitis group(50.00%)was lower than that in the spinal tuberculosis group(88.89%),the proportion of focal signals(30.43%)was higher than that in the spinal tuberculosis group(11.11%),and the proportion of fan-shaped signals(23.08%)was higher than that in the spinal tuberculosis group(0).There was a significant difference between the two groups in terms of vertebral body destruction and intervertebral disc stenosis(P<0.05).Among them,the proportion of vertebral collapse(0)in the spondylitis group was lower than that in the spinal tuberculosis group(43.52%),the proportion of kyphosis deformity(3.85%)was lower than that in the spinal tuberculosis group(24.07%),and the proportion of bone destruction around the intervertebral disc(46.15%)was higher than that in the spinal tuberculosis group(10.19%).Comparison of abscess signals between two groups:the proportion of paravertebral abscesses in the spinal tuberculosis group(54.02%)was higher than that in the spinal tuberculosis group(30.43%),the proportion of abnormal signals in the paravertebral soft tissue in the spinal tuberculosis group(91.95%)was higher than that in the spinal tuberculosis group(52.17%),and the proportion of abscesses under the ligament in the spinal tuberculosis group≥3 vertebral levels(6.67%)was lower than that in the spinal tuberculosis group(57.75%),with statistically significant differences(P<0.05);There was no significant difference in the proportion of epidural abscess(47.83%),epidural abscess with neurological symptoms(34.78%),and abscess under anterior longitudinal ligament(65.22%)between the spondylitis group and the spinal tuberculosis group(P>0.05).Conclusion The degree of bone destruction,vertebral signal shape,paravertebral abscess,paravertebral soft tissue abnormal signal,and abscess diffusion in MRI examination of patients with Brucella spondylitis and spinal tuberculosis are significantly different,which can provide an important reference for clinicians to identify the two diseases.