CT在脊柱单椎体结核中的影像学特点和临床应用价值

The imaging characteristics and clinical application value of CT in the treatment of spinal monovertebral tuberculosis

目的探讨CT在脊柱单椎体结核中的影像学特点和临床应用价值。方法回顾性分析2017年1月至2020年12月本院脊柱外科接诊的85例疑似脊柱单椎体结核患者的临床资料,均行X线、CT、MRI检查。以手术病理诊断结果为金标准,分析X线、CT、MRI对脊柱单椎体结核的诊断效能;比较X线、CT、MRI对脊柱单椎体结核不同临床特征的诊断符合率;比较脊柱单椎体结核患者和非脊柱单椎体结核患者的不同CT表现发生率。结果85例疑似脊柱单椎体结核患者中,经手术病理诊断脊柱单椎体结核54例、非脊柱单椎体结核31例。X线、CT、MRI诊断脊柱单椎体结核的灵敏度、特异度、准确率、阳性预测值、阴性预测值比较差异有统计学意义(P<0.05);CT、MRI诊断脊柱单椎体结核的灵敏度、特异度、准确率、阳性预测值、阴性预测值均高于X线,差异有统计学意义(P<0.05),CT、MRI诊断脊柱单椎体结核的灵敏度、特异度、准确率、阳性预测值、阴性预测值比较差异无统计学意义。X线与手术病理诊断结果具有中度一致性(Kappa=0.510,P<0.05);CT、MRI诊断结果与手术病理诊断结果具有较高一致性(Kappa=0.723、0.749,P<0.05)。X线、CT、MRI对椎体骨质破坏、椎管狭窄、椎旁脓肿、死骨形成的诊断符合率比较差异有统计学意义(P<0.05);CT与MRI对椎体骨质破坏、椎管狭窄、椎旁脓肿、死骨形成的诊断符合率均高于X线,差异有统计学意义(P<0.05),CT与MRI对椎体骨质破坏、椎管狭窄、椎旁脓肿、死骨形成的诊断符合率比较差异无统计学意义。脊柱单椎体结核患者CT表现病灶边缘硬化、死骨、骨膜反应、椎旁脓肿、椎旁肿块强化、椎旁肿块内钙化发生率均高于非脊柱单椎体结核患者,差异有统计学意义(P<0.05)。结论CT对脊柱单椎体结核的诊断准确率高于X线,与MRI相当,具有良好的诊断价值;与MRI相比,CT检查费用低、扫描时间短,患者耐受性及依从性较高,可减轻患者经济负担,具有临床推广应用价值。

Objective To investigate the imaging characteristics and clinical application value of CT in the treatment of spinal monovertebral tuberculosis.Methods The clinical data of 85 suspected patients with spinal monovertebral tuberculosis admitted to the Spinal Surgery department of our hospital from January 2017 to December 2020 were retrospectively analyzed,X-ray,CT and MRI examinations were performed.The diagnostic efficacy of X-ray,CT and MRI in the diagnosis of spinal monovertebral tuberculosis was analyzed with the results of surgical pathological diagnosis as the gold standard;the diagnostic coincidence rate of X-ray,CT and MRI for different clinical features of spinal monovertebral tuberculosis was compared;the incidence of different CT findings in patients with spinal monovertebral tuberculosis and non-spinal monovertebral tuberculosis.Results Among 85 patients with spinal monovertebral tuberculosis,54 cases of spinal monovertebral tuberculosis and 31 cases of non-spinal monovertebral tuberculosis were surgical pathological diagnosis.There were significant differences in sensitivity,specificity,accuracy,positive predictive value and negative predictive value of X-ray,CT and MRI in the diagnosis of spinal single vertebral tuberculosis(P<0.05);the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of CT and MRI in the diagnosis of spinal monovertebral tuberculosis were higher than those of X-ray,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the sensitivity,specificity,accuracy,positive predictive value and negative predictive value between CT and MRI in the diagnosis of spinal monovertebral tuberculosis.There was moderate consistency between X-ray and pathologic diagnosis(Kappa=0.510,P<0.05);the results of CT and MRI were consistent with those of surgical pathology(Kappa=0.723,0.749,P<0.05).There were significant differences in the diagnostic coincidence rates of vertebral bone destruction,spinal stenosis,paravertebral abscess and dead bone formation among X-ray,CT and MRI(P<0.05);the diagnostic coincidence rate of CT and MRI for vertebral bone destruction,spinal canal stenosis,paravertebral abscess and dead bone formation was higher than that of X-ray,and the differences were statistically significant(P<0.05),the diagnostic coincidence rate between CT and MRI for vertebral bone destruction,spinal canal stenosis,paravertebral abscess and dead bone formation was not statistically significant.The CT findings incidence of lesion edge sclerosis,sequeum,periosteal reaction,paravertebral abscess,paravertebral mass enhancement and calcification in the paravertebral mass in patients with spinal monovertebral tuberculosiswas higher than that in patients with non-spinal monovertebral tuberculosis,and the differences were statistically significant(P<0.05).Conclusion The diagnostic accuracy of CT in single spinal tuberculosis is better than that of X-ray,and is equivalent to that of MRI,which has good diagnostic value;compared with MRI,CT examination has lower cost,shorter scanning time,higher tolerance and compliance of patients,which is more conducive to the promotion and popularization of clinical application,can reduce the economic burden of patients,and has clinical application value.