脊柱化脓性感染抗生素治疗成功后预测椎体病灶融合的临床和放射学特征

Clinical and radiological features of predicting fusion of vertebral lesions after successful antibiotic treatment of pyogenic spinal infection

目的探讨脊柱化脓性感染(pyogenic spinal infection,PSI)抗生素治疗成功后,预测椎体病灶融合的临床和放射学特征。方法对68例经抗生素治疗后完全治愈且无复发的PSI患者进行研究,随访时间6个月,根据患者椎体病灶是否融合分为A组(椎体病灶融合组,37例)和B组(非椎体病灶融合组,31例)。观察两组患者临床资料和影像特征[PSI病变椎间盘和终板在内的椎间结构上最大标准化18F-FPG摄取值(SUVmax)、18F-FDG-PET摄取18F-FDG的分布模式、T1加权对比度(T1 weighted contrast,T1C)MRI上的对比增强、T2加权脂肪饱和度(T2 weighted fat saturation,T2FS)MRI高信号强度等]差异。结果A组和B组患者年龄、性别、病变节段、病灶位置、病因、起始症状、C反应蛋白(C-reactive protein,CRP)、VAS评分等差异均无统计学意义(P>0.05);A组患者血沉(erythrocyte sedimentation rate,ESR)水平高于B组,差异有统计学意义(P<0.05)。抗生素治疗6周时,A组ESR和椎间结构SUVmax高于B组,差异均有统计学意义(P<0.05);两组患者CRP、VAS、SUVmax位置等差异均无统计学意义(P>0.05)。A组和B组患者病原菌检出类型差异均无统计学意义(P>0.05);A组患者抗生素应用时间高于B组,差异存在统计学意义(P<0.05)。两组患者18F-FDG-PET上18F-FDG摄取、T1CMRI对比增强等分布差异均无统计学意义(P>0.05);两组患者T2FS MRI高信号强度分布差异存在统计学意义(P<0.05)。结论ESR升高、T2FS MRI广泛水肿变化、18F-FDG-PET上更高的18F-FDG摄取与椎体病灶融合相关,有助于评估PSI的治疗反应。

Objective To investigate the clinical and radiological characteristics of predicting fusion of vertebral lesions after successful antibiotic treatment of pyogenic spinal infection(PSI).Methods Sixty-eight patients with PSI who were completely cured without recurrence after antibiotic treatment were studied.The patients were followed up for six months.They were divided into group A(fusion of vertebral lesions group,n=37 cases)and group B(non fusion of vertebral lesions group,n=31 cases).The differences of clinical data and imaging characteristics[Maximum standardized 18F-FPG uptake value(SUVmax)on intervertebral structures,including intervertebral discs and endplates,distribution pattern of 18F-FDG-PET uptake of 18-F-FDDG,contrast enhancement on T1 weighted contrast(T1C)MRI,T2 weighted fat saturation(T2FS)MRI high signal intensity,etc.]between the two groups were observed.Results There was no significant difference between group A and group B in age,sex,lesion segment,injury location,etiology,initial symptoms,CRP,VAS and so on(P>0.05).The level of ESR in group A was higher than that in group B,and the difference was statistically significant(P<0.05).ESR and SUVmax of intervertebral structure in group A were significantly higher than those in group B after six weeks of antibiotic treatment(P<0.05).There was no significant difference in CRP,VAS,SUVmax position between the two groups(P>0.05).There was no significant difference in the types of pathogenic bacteria between the two groups(P>0.05).The antibiotic time of group A was longer than that of group B,and the difference was statistically significant(P<0.05).There was no significant difference in 18F-FDG uptake on 18F-FDG-PET and T1CMRI contrast enhancement between the two groups(P>0.05).There was significant difference in the distribution of T2FS MRI high signal intensity between the two groups(P<0.05).Conclusion Elevated ESR,extensive edema changes on T2FS MRI and higher 18F-FDG uptake on 18F-FDG-PET are associated with the fusion of vertebral lesions,which are helpful for the evaluation of the therapeutic response of PSI.