Ahmadi J, Bajaj A, Destian S, Segall H D, Zee C S
Department of Radiology, University of Southern California School of Medicine, LAC-USC Medical Center 90033.
Radiology. 1993 Nov;189(2):489-93. doi: 10.1148/radiology.189.2.8210378.
To evaluate atypical magnetic resonance (MR) imaging features of spinal tuberculosis.
Between 1990 and 1993, five of 11 consecutive patients with spinal tuberculosis (two men and three women, aged 30-57 years) had MR findings more suggestive of neoplasm than infection. One patient, a European immigrant, had acquired immunodeficiency syndrome (AIDS).
Areas involved with tuberculosis were hypointense on T1-weighted images and hyperintense on T2-weighted images, and became enhanced with gadopentetate dimeglumine. In two patients, tuberculosis affected only a single vertebral body without paraspinal abscesses or involvement of the end plates and disk spaces. In two other patients, only a single spinous process was replaced with tuberculous abscess. In the remaining patient, the sacrum and multiple lower lumbar vertebrae were affected, but the intervertebral disk spaces were not affected. More typical findings of spinal tuberculosis include destruction of two adjacent vertebral bodies and opposing end plates, destruction of intervening disk space, and/or occurrence of paravertebral abscesses.
Neither clinical examination nor MR findings may be reliable in helping differentiate spinal infections from one another or from neoplasm. Adequate biopsy is essential for early diagnosis and prompt treatment.
评估脊柱结核的非典型磁共振（MR）成像特征。
1990年至1993年间，11例连续的脊柱结核患者中有5例（2例男性，3例女性，年龄30 - 57岁）的MR表现更提示肿瘤而非感染。其中1例患者为欧洲移民，患有获得性免疫缺陷综合征（AIDS）。
结核累及区域在T1加权像上呈低信号，在T2加权像上呈高信号，注射钆喷酸葡胺后强化。2例患者中，结核仅累及单个椎体，无椎旁脓肿，终板和椎间盘间隙未受累。另外2例患者中，仅单个棘突被结核脓肿取代。其余患者中，骶骨和多个下腰椎椎体受累，但椎间盘间隙未受累。脊柱结核更典型的表现包括两个相邻椎体及相对终板破坏、其间椎间盘间隙破坏和/或椎旁脓肿形成。
临床检查和MR表现均可能无法可靠地区分脊柱感染之间或与肿瘤的差异。充分的活检对于早期诊断和及时治疗至关重要。
