脊髓结核MRI影像表现及分型

Manifestations and classification of MRI imaging of spinal cord tuberculosis

目的:分析脊髓结核MRI影像表现及分型。方法:采用回顾性研究方法,参照入组标准收集2019年5月至2021年12月在昆明市第三人民医院首次诊断为颅内结核合并脊髓结核的82例患者的MRI影像资料,总结影像学表现并进行分型分析。结果:根据是否累及脊髓表面脊膜和脊髓实质,将82例脊髓结核患者MRI影像表现分为脊髓实质型[42例(51.2%)]、脊膜型[36例(43.9%)]和混合型[4例(4.9%)]。其中,脊髓实质型表现为脊髓实质内单发或多发的结节状强化或环状强化病灶,伴或不伴脊髓水肿,且合并血行播散性肺结核的比例[64.3%(27/42)]高于脊膜型[30.6%(11/36)],合并活动性继发性肺结核[31.0%(13/42)]和结核性脑膜炎的比例[81.0%(34/42)]均低于脊膜型[分别为61.1%(22/36)和97.2%(35/36)],差异均有统计学意义(χ^(2)=8.828,P=0.003;χ^(2)=7.127,P=0.008;χ^(2)=5.027,P=0.025);脊膜型表现为软脊膜线样增厚和(或)蛛网膜下腔结核瘤但无脊髓实质病灶,可伴有脊髓水肿、脊髓空洞或蛛网膜下腔粘连;混合型同时具备以上两型表现。结论:脊髓结核以脊髓实质型MRI表现为主,其次是脊膜型,而混合型少见,参照各型具有的MRI特征可增强MRI的诊断价值。

Objective:To analysis the MRI imaging manifestations and staging of spinal cord tuberculosis.Methods:A retrospective study method was used to include the MRI imaging data of 82 patients who were diagnosed with intracranial tuberculosis combined with spinal cord tuberculosis for the first time at the Third People’s Hospital of Kunming from May 2019 to December 2021 according to the enrollment criteria,to summarize the imaging manifestations and staging.Results:The MRI imaging manifestations of 82 cases of spinal cord tuberculosis were classified into spinal cord parenchymal type(42 cases,51.2%),spinal meninges type(36 cases,43.9%),and mixed type(4 cases,4.9%)according to the involvement or not of spinal membrane and spinal cord parenchyma.Among them,the spinal cord parenchymal type showed the single or multiple nodular enhancing or ring enhancing lesions in the spinal cord parenchyma,with or without spinal cord oedema,and the proportion(64.3%(27/42))combined with haematogenous disseminated tuberculosis was higher than in the spinal meninges type group(30.6%,11/36),and was more likely to combine with active secondary tuberculosis(31.0%,13/42)and tuberculous meningitis(81.0%,34/42)than that of the spinal meninges type group(61.1%,22/36 and 97.2%,35/36,respectively),with statistically significant differences(χ^(2)=8.828,P=0.003;χ^(2)=7.127,P=0.008;χ^(2)=5.027,P=0.025).The spinal meninges type presented linear thickening of the soft spinal cord membrane and/or subarachnoid tuberculoma without spinal cord parenchymal lesions,which might be accompanied with spinal cord oedema,syringomyelia,or subarachnoid adhesions;the mixed type presented both of the above manifestations.Conclusion:Spinal cord tuberculosis is predominantly manifested by MRI of the spinal cord parenchymal type,followed by the spinal meningeal type,while the mixed type is rare,and the diagnostic value of MRI can be enhanced by taking the MRI features of each type as reference.