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布鲁氏菌性脊柱炎与结核性脊柱炎的影像学诊断

[Imaging diagnosis of brucella spondylitis and tuberculous spondylitis].

作者信息

Li W, Zhao Y H, Liu J, Duan Y W, Gao M, Lu Y T, Yao L, Li S L

机构信息

Department of Radiology, the Fifth Affiliated Hospital Sun Yat-sen University, Zhuhai 519000, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2018 Aug 7;98(29):2341-2345. doi: 10.3760/cma.j.issn.0376-2491.2018.29.013.

Abstract

To compare the characteristics of X-ray, CT and MRI of Brucella spondylitis and tuberculous spondylitis and its significance for differential diagnosis. A total of 10 cases of Brucella spondylitis and 20 cases of tuberculous spondylitis confirmed from the clinical, laboratory or pathological department were enrolled between January 2014 and August 2017 in the Fifth Affiliated Hospital of Sun Yat-sen University and the Third Affiliated Hospital of Southern Medical University. The CT, MRI findings were retrospectively analyzed to improve the differential diagnosis of these two diseases. Of the 10 cases of Brucella spondylitis, 8 were located only in the lumbosacral vertebrae, 1 in the thoracic vertebrae only, 1 in the cervical and thoracic vertebrae, 8 with invasive bone destruction, and 8 with narrowed intervertebral space. In 9 cases of intervertebral disc destruction, 7 cases developed paravertebral abscesses, 3 cases had sclerotic edges, all cases had no vertebral body flattening, 5 cases invaded the accessory, 4 cases formed sequestrum, and 6 cases invaded the spinal canal. There were 3 cases showing invasion of surrounding muscles. In 20 cases of tuberculous spondylitis, 12 cases were located in the lumbosacral vertebrae, 6 cases in the thoracic vertebrae only, 1 involved the thoracic vertebrae and lumbosacral vertebrae, 1 involved the neck, chest, and lumbosacral vertebrae. Bone destruction of bone, 19 cases of intervertebral space narrowing, 20 cases of intervertebral disc destruction, 18 cases of paraspinal abscess formation, 10 cases of sclerotic edge formation, 6 cases of vertebral body flattened, 16 cases of invading attachment. There were 17 cases of sequestrum formation, 13 cases of invasion of the spinal canal, and 12 cases of violation of surrounding muscles. There were statistical differences between the two types of imaging signs such as the type of vertebral destruction and the presence or absence of sequestrum. The type of vertebral destruction and the presence or absence of imaging features such as sequestrumwill facilitate the differential diagnosis of Brucella spondylitis and tuberculous spondylitis.

摘要

比较布鲁氏菌性脊柱炎与脊柱结核的X线、CT及MRI表现特点及其对鉴别诊断的意义。2014年1月至2017年8月,中山大学附属第五医院及南方医科大学第三附属医院共纳入10例经临床、实验室或病理确诊的布鲁氏菌性脊柱炎患者及20例脊柱结核患者。回顾性分析其CT、MRI表现,以提高对这两种疾病的鉴别诊断能力。10例布鲁氏菌性脊柱炎患者中,8例仅累及腰骶椎,1例仅累及胸椎,1例累及颈椎和胸椎;8例有骨质浸润性破坏,8例椎间隙变窄;9例椎间盘破坏,7例形成椎旁脓肿,3例骨质边缘硬化,所有病例椎体均无扁平,5例累及附件,4例形成死骨,6例侵犯椎管,3例显示周围肌肉受侵。20例脊柱结核患者中,12例累及腰骶椎,6例仅累及胸椎,1例累及胸椎和腰骶椎,1例累及颈、胸、腰骶椎;骨质破坏19例,椎间隙变窄20例,椎间盘破坏20例,椎旁脓肿形成18例,骨质边缘硬化10例,椎体扁平6例,侵犯附件16例,死骨形成17例,侵犯椎管13例,侵犯周围肌肉12例。两种类型的影像学征象如椎体破坏类型及死骨的有无等存在统计学差异。椎体破坏类型及死骨等影像学特征的有无有助于布鲁氏菌性脊柱炎与脊柱结核的鉴别诊断。

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