20例布氏杆菌性脊柱炎的临床及MR征象分析

Analysis on the clinical pictures and MR signs of brucellosis spondylitis in 20 cases

目的:探索20例布氏杆菌脊柱炎患者的临床及MR征象,分析其临床和MR资料,提高认识、诊断水平。方法:回顾性分析阜阳市第二人民医院经实验室检查确诊的20例布氏杆菌脊柱炎的临床及MR影像学资料,其中5例加扫DWI和增强序列。结果:20例中均有腰椎受累,合并骶椎受累2例,合并胸椎受累2例;单个椎体受累6例(30.00%),1例表现为椎体边缘斑片状长T1/长T2信号,同时合并周围软组织受累,5例常规MR椎体信号无明显改变,DWI可见椎体前上缘稍高信号、增强可见少许强化,未见周围软组织受累;2个椎体受累9例(45.00%),均为相邻椎体受累,均同时合并椎间隙及椎旁软组织受累肿胀、信号增高,椎体形态无明显改变,呈长T1/长T2骨质破坏,压脂像显示明显高信号;3个椎体受累2例(10.00%),均为相邻椎体受累,同时合并椎间隙和周围软组织受累;4个椎体受累3例(15.00%),均为两两相邻椎体骨质破坏,且同时合并椎间隙及椎旁软组织受累。结论:MR对布氏杆菌脊柱炎有较高诊断价值,同时对于早期病变常规MR未见异常信号改变时,DWI示椎体前上缘稍高信号、增强可见强化,具有重要提示意义。

Objective:To investigate the clinical and magnetic resonance imaging(MR)features of brucellosis spondylitis in 20 cases,and analyze the clinical and imaging data of brucellosis spondylitis so as to improve understanding and diagnosis of this spine condition.Methods:The clinical and MR data were retrospectively analyzed in 20 cases of brucellosis spondylitis that were confirmed by laboratory studies in Fuyang City,Anhui Province.Of the 20 patients,five underwent scanning with diffusion weighted imaging(DWI)and enhanced MR.Results:The 20 cases were generally involved in lumbar spine,in whom involvement occurred in sacral spine in 2,and in thoracic spine in another 2.Six cases(30.00%)were just single vertebral body involvement.One case showed patchy long T1 and long T2 signal at the edge of the vertebral body,combined with peripheral soft tissue involvement.Five cases had no obvious change in conventional MR vertebral body signal,yet DWI exhibited slightly higher signal at the vertebral body margin,enhancement with somewhat strengthening,and no peripheral soft tissue involvement.Involvement was seen in the two vertebral bodies in 9 cases(45.00%),all of which occurred in adjacent vertebral body and were combined with intervertebral space and paravertebral soft tissue involvement,showing swollen tissues and enhanced signal at MR.There was no obvious change in vertebral body morphology,yet bone destruction was seen at long T1/long T2.Lipid compression imaging sequence was obvious,and showed high signal.Involvement of the three vertebral bodies was seen in 2 cases(10.00%),and the involvement generally occurred in adjacent vertebral bodies,with intervertebral space and peripheral soft tissues affected.Four vertebral bodies were affected in 3 cases(15.00%),resulting in bone destruction in two adjacent vertebral bodies,and concurrent intervertebral space and paravertebral soft tissue involvement.Conclusion:MR has higher diagnostic value for brucellosis spondylitis,yet shows no abnormal signal in conventional scanning for early lesions.DWI exhibiting a slightly higher signal on the anterior margin of vertebral body with enhancement in enhanced scanning is of great significance for diagnosis of this disorder.