念珠菌性脊柱炎：与细菌性和结核性病因的 MRI 表现比较。

Candida spondylitis: Comparison of MRI findings with bacterial and tuberculous causes.

机构信息

1 Department of Radiology, Gachon University Gil Medical Center, Inchoen, Korea.

出版信息

AJR Am J Roentgenol. 2013 Oct;201(4):872-7. doi: 10.2214/AJR.12.10344.

DOI:10.2214/AJR.12.10344

PMID:24059378

Abstract

OBJECTIVE

Candida spondylitis is relatively uncommon and is usually encountered as an opportunistic infection. We analyzed the MRI characteristics of biopsy-proven cases of Candida spondylitis, and compared the findings with bacterial or tuberculous spondylitis.

MATERIALS AND METHODS

The study included patients with infectious spondylitis who underwent MRI and biopsy from 1998 to 2011 (60 patients; mean age 56 ± 18 years). MR images were analyzed with respect to the number of involved vertebrae, contrast enhancement pattern, signal intensity of spinal inflammatory masses on T2-weighted imaging, paraspinal abscess size, intervertebral disk destruction, subligamentous spread, and skip lesions. The Fisher exact test and analysis of variance were used for statistical analysis.

RESULTS

There were 10 cases of Candida spondylitis, and 29 and 21 cases of bacterial and tuberculous spondylitis, respectively. On MRI, disk destruction was seen in 50%, 93%, and 30% of Candida, bacterial, and tuberculous cases, respectively. Subligamentous spread of infection was noted in 22%, 10%, and 85%. Paraspinal inflammatory masses were seen in 100%, 100%, and 76%, and abscesses in 100%, 66%, and 90%, of Candida, bacterial, and tuberculous cases, respectively. Paraspinal inflammatory masses contained low T2 signal intensity portions in 80%, 21%, and 67%, and skip lesions were seen in 0%, 10%, and 14%, respectively. Small abscesses were noted in 100%, 76%, and 35% of Candida, bacteria, and tuberculosis infections, respectively. Candida involved 2.3 ± 0.4 vertebrae compared with 2.3 ± 0.9 and 3.0 ± 1.7 in bacterial and tuberculous, respectively. Differences in the three groups were statistically significant (p < 0.05) except for the number of involved vertebrae, and skip lesions.

CONCLUSION

Candida spondylitis can be suspected when infectious lesions contain low-signal spinal inflammatory masses on T2-weighted imaging, small paraspinal abscesses, and in immunocompromised patients.

摘要

目的

念珠菌性脊柱炎相对少见，通常为机会性感染。我们分析了经活检证实的念珠菌性脊柱炎的 MRI 特征，并与细菌性或结核性脊柱炎进行了比较。

材料和方法

本研究纳入了 1998 年至 2011 年间因感染性脊柱炎行 MRI 检查和活检的患者（60 例；平均年龄 56±18 岁）。分析 MRI 上受累椎体数量、对比增强模式、T2 加权成像上脊柱炎症肿块的信号强度、椎旁脓肿大小、椎间盘破坏、韧带下蔓延和跳跃性病变。采用 Fisher 确切概率检验和方差分析进行统计学分析。

结果

共 10 例念珠菌性脊柱炎，29 例细菌性脊柱炎和 21 例结核性脊柱炎。MRI 显示，50%、93%和 30%的念珠菌性、细菌性和结核性脊柱炎患者存在椎间盘破坏。22%、10%和 85%的感染存在韧带下蔓延。100%、100%和 76%的念珠菌性、细菌性和结核性脊柱炎患者存在椎旁炎症肿块，100%、66%和 90%的患者存在脓肿。80%、21%和 67%的念珠菌性、细菌性和结核性脊柱炎的椎旁炎症肿块包含 T2 信号强度低的部分，0%、10%和 14%存在跳跃性病变。100%、76%和 35%的念珠菌性、细菌性和结核性感染患者存在小脓肿。念珠菌性脊柱炎累及 2.3±0.4 个椎体，细菌性和结核性脊柱炎分别累及 2.3±0.9 和 3.0±1.7 个椎体，差异有统计学意义（p<0.05），除受累椎体数和跳跃性病变外。