Diagnosis and differentiation of spinal tuberculosis by CT and MRI
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摘要:
目的分析脊椎结核CT、MRI诊断与鉴别特征及表现。 方法选取我院2014年1月~2019年1月收治的脊椎结核患者80例，分别接受CT、MRI诊断。所有图像经工作站处理后由3名经验丰富的影像学医生进行评定，以符合病理及解剖结果作为阳性标准。比较两组患者的脊椎结核病位阳性情况、脊椎结核侵犯程度、病理分期。 结果CT、MRI及CT联合MRI诊断脊椎结核病位阳性率差异有统计学意义（P < 0.05）。阳性率由高到低依次是CT联合MRI、MRI、CT。CT、MRI、CT联合MRI诊断骨质、椎间盘破坏、椎旁肿块或脓肿、硬膜囊外或椎管侵犯、脊膜强化、钙化阳性率差异有统计学意义（P < 0.05），韧带下扩散差异无统计学意义（P > 0.05）。骨质、椎间盘破坏、椎旁肿块或脓肿阳性率由高依次是CT联合MRI、MRI、CT。CT诊断硬膜囊外或椎管侵犯、脊膜强化阳性率最低，MRI、CT联合MRI阳性率相同。CT、MRI、CT联合MRI诊断渗出期、增殖期、干酪样变性期阳性率差异比较有统计学意义（P < 0.05）。阳性率由高到低依次是CT联合MRI、MRI、CT。 结论脊椎结核CT、MRI诊断价值、特征不同，其中联合诊断能提高脊椎结核准确性，减少漏诊情况，同时联合诊断还能鉴别疑似病例，减少误诊。 Abstract:ObjectiveTo investigate the characteristics and manifestations of CT and MRI in the diagnosis and differentiation of spinal tuberculosis. MethodsEighty patients with spinal tuberculosis admitted to our hospital from January 2014 to January 2019 were selected. The patients received the CT and MRI examinations. All images were read by 3 experienced radiologists. Pathological and anatomical results were taken as criteria. The positive status, invasion degree and pathological stage of spinal tuberculosis were compared between groups. ResultsThe positive rates of lesion sites presented by CT, MRI and CT combined with MRI were significant different (P < 0.05), which was highest by CT combined with MRI, followed by MRI and CT (P < 0.05). The positive rates of CT, MRI, CT combined with MRI in the diagnosis of bone, disc destruction, paravertebral mass or abscess, epidural or spinal canal invasion, spinal meningeal enhancement and calcification had significant difference (P < 0.05). The CT, MRI, CT combined with MRI had no significant difference in the diagnosis of subcortical diffusion (P > 0.05). The positive rates of bone, disc destruction, paravertebral mass or abscess, and spinal membrane enhancement were the highest by CT combined with MRI (P < 0.05). The positive rate of epidural or spinal canal invasion and spinal membrane enhancement was the lowest presented by CT, and those of MRI and CT combined MRI were the same. The positive rates of CT, MRI and CT combined with MRI in the diagnosis of exudation, proliferation and caseous degeneration were significantly different (P < 0.05), which was highest by CT combined with MRI, followed by MRI and CT (P < 0.05). ConclusionThe diagnostic value and characteristics of CT and MRI of spinal tuberculosis are different. The combined diagnosis can improve the accuracy of spinal tuberculosis, and reduce the missed diagnosis and misdiagnosis. -
Key words:
- spinal tuberculosis /
- CT /
- MRI /
- diagnosis /
- aggression
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图 1 脊椎结核CT图
A: CT冠状位显示腰椎椎旁脓肿、椎旁钙化; B: CT轴位显示腰椎骨质破坏和椎旁软组织肿胀; C: CT冠状位显示椎体破坏和椎旁脓肿; D: CT冠状位显示椎体小关节骨密度增高和破坏; E-F: CT冠状位, 棘突骨密度增高和背部软组织肿胀.
Figure 1. CT image of spinal tuberculosis.
图 2 脊椎结核MRI图
A: MR矢状位, 椎旁软组织肿胀; B-C: MR冠状位, 椎旁软组织肿胀; D: MR矢状位, 椎体及椎间盘受累及, 信号增高; E: MR轴位T2, 重点显示椎两侧旁脓肿; F: MR矢状位显示椎旁软组织肿胀.
Figure 2. MRI image of spinal tuberculosis.
表 1 CT、MRI诊断脊椎结核病位情况比较
Table 1. Comparison of CT and MRI in the diagnosis of lesion sites of spinal tuberculosis[n(%)]
诊断方法 脊椎结核病位 颈椎(n=8) 胸椎(n=24) 胸腰段(n=16) 腰椎(n=32) CT 4 (50.00) 17 (70.83) 10 (62.50) 23 (71.88) MRI 5 (62.50) 21 (57.50) 13 (81.25) 28 (87.50) CT联合MRI 8 (100.00) 23 (95.83) 14 (87.50) 30 (93.75) χ2 13.879 16.695 10.234 26.574 P < 0.001 < 0.001 < 0.001 < 0.001 
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表 2 CT、MRI诊断脊椎结核侵犯程度比较
Table 2. Comparison of CT and MRI in the diagnosis of invasion degree of spinal tuberculosis[n(%)]
诊断方法 侵犯程度 骨质、椎间盘破坏(n=39) 椎旁肿块或脓肿(n=18) 硬膜囊外或椎管侵犯(n=3) 韧带下扩散(n=13) 脊膜强化(n=3) 钙化(n=4) CT 24 (61.54) 12 (66.67) 1 (33.33) 10 (76.92) 1 (33.33) 4 (100.00) MRI 35 (89.75) 14 (77.78) 3 (100.00) 11 (84.62) 3 (100.00) 0 (0.00) CT联合MRI 39 (100.00) 16 (88.89) 3 (100.00) 12 (92.31) 3 (100.00) 4 (100.00) χ2 20.597 15.681 24.597 3.597 32.587 85.264 P < 0.001 < 0.001 < 0.001 0.741 < 0.001 < 0.001
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表 3 CT、MRI诊断脊椎结核病理分期比较
Table 3. Comparison of CT and MRI in the diagnosis of pathological stages of spinal tuberculosis[n(%)]
诊断方法 病理分期 渗出期(n=14) 增殖期(n=20) 干酪样变性期(n=46) CT 6 (42.86) 13 (65.00) 32 (69.57) MRI 9 (64.29) 17 (85.00) 38 (82.61) CT联合MRI 11 (78.57) 20 (100.00) 42 (91.30) Z -59.687 P < 0.001
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