多节段布鲁菌性与结核性脊柱炎MRI特征分析
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摘要
目的探讨多节段布鲁菌性与结核性脊柱炎的MRI表现,提高鉴别诊断能力。方法选取2012年1月—2015年12月收治的18例多节段布鲁菌性脊柱炎(布病组)与34例多节段结核性脊柱炎(结核组),均行MRI检查,记录所有患者的临床症状和MRI表现。结果布病组以腰痛为主,波状热、运动受限、下肢疼痛亦常见,其中3例伴髋关节疼痛;结核组以持续性腰背部疼痛为主,运动受限、午后盗汗、发热亦常见,且9例伴脊柱后凸畸形,其中2例背部可见包块,1例伴下肢瘫痪。两组下肢疼痛比较差异有统计学意义(P<0.05)。布病组多累及2个椎体,且腰骶椎发病率最高,尤其以腰5骶1最常见,多侵袭椎体前、中、后部,椎间隙狭窄常小于正常1/2;结核组多累及4个椎体,且胸腰椎发病率最高,均侵袭椎体前、中、后部,椎间隙狭窄常大于正常1/2。两组累及椎体范围、椎间隙狭窄小于正常1/2、病变椎体为胸腰椎及腰骶椎比较差异有统计学意义(P<0.05)。布病组位居前三位的MRI征象分别为椎体未变扁、椎间盘受累、椎旁脓肿,结核组位居前三位的MRI征象分别为椎间盘受累、椎旁脓肿、椎管狭窄。两组椎间盘受累、椎旁脓肿伴椎管狭窄、腰大肌脓肿、腰大肌脓肿伴椎旁脓肿、腰大肌脓肿伴椎管狭窄、椎体未变扁、周围肌肉水肿、脊髓水肿比较差异有统计学意义(P<0.05)。结论多节段布鲁菌性与结核性脊柱炎临床症状、MRI表现存在差异,综合分析有助于早期鉴别诊断及指导治疗,避免误诊或等待检查结果而加重患者病情。
Objective To explore the MRI manifestations of multi-segmental brucella spondylitis and tuberculous spondylitis in order to improve the differential diagnosis level. Methods Eighteen cases with multi-segmental brucella spondylitis(brucellosis Group) and 34 cases with multi-segmental tuberculous spondylitis(tuberculosis Group) who were admitted from January 2012 to December 2015 were selected. All patients underwent MRI, and the clinical symptoms and MRI manifestations were recorded. Results Low back pain was the main symptom in brucellosis group. In the meantime, the wavy fever, restricted movement and lower limb pain were also common that included 3 cases with hip pain. The persistent low back pain was the main factor in tuberculosis group. And then, restricted movement, night sweats and fever were also common, and 9 cases had kyphosis deformity that included 2 cases of lumbar mass and 1 case of lower limb paralysis. There was significant difference in lower limb pain between the two groups(P<0.05). Two vertebra were involved in brucellosis group, and the incidence of lumbosacral vertebrae was the highest, especially in lumbosacral 5-sacral 1 segments. Anterior, middle and posterior parts of vertebrae mostly got involved, and the intervertebral space stenosis was often less than the normal 1/2. Four vertebra were involved in tuberculosis group, and the incidence of thoracolumbar vertebrae was the highest. And then, the anterior, middle and posterior parts of vertebrae were involved. The intervertebral space stenosis was often greater than normal 1/2. There were significantly statistical differences in the range of vertebral body involved, intervertebral space stenosis(less than 1/2), and lesions of thoracolumbar vertebrae and lumbosacral vertebrae in the two groups(P<0.05). The top three MRI signs of brucellosis group were vertebral body without flattening, intervertebral disc involvement and paravertebral abscess, respectively. On the other hand, the top three MRI signs of tuberculosis group were intervertebral disc involvement, paravertebral abscess and spinal stenosis, respectively. There were significant differences in intervertebral disc involvement, paravertebral abscess with spinal stenosis, psoas major abscess with paravertebral abscess, psoas major abscess with paravertebral abscess, psoas major abscess with spinal stenosis, vertebral body without flattening, peripheral muscle edema and spinal cord edema between the two groups(P<0.05). Conclusion The multi-segmental brucella spondylitis and tuberculous spondylitis have different clinical symptoms and MRI characteristics. Therefore, comprehensive analysis is helpful for early differential diagnosis,guidance of treatment, and avoidance of misdiagnosis or waiting for the results of the examination which aggravates the patient's condition.
Objective To explore the MRI manifestations of multi-segmental brucella spondylitis and tuberculous spondylitis in order to improve the differential diagnosis level. Methods Eighteen cases with multi-segmental brucella spondylitis(brucellosis Group) and 34 cases with multi-segmental tuberculous spondylitis(tuberculosis Group) who were admitted from January 2012 to December 2015 were selected. All patients underwent MRI, and the clinical symptoms and MRI manifestations were recorded. Results Low back pain was the main symptom in brucellosis group. In the meantime, the wavy fever, restricted movement and lower limb pain were also common that included 3 cases with hip pain. The persistent low back pain was the main factor in tuberculosis group. And then, restricted movement, night sweats and fever were also common, and 9 cases had kyphosis deformity that included 2 cases of lumbar mass and 1 case of lower limb paralysis. There was significant difference in lower limb pain between the two groups(P<0.05). Two vertebra were involved in brucellosis group, and the incidence of lumbosacral vertebrae was the highest, especially in lumbosacral 5-sacral 1 segments. Anterior, middle and posterior parts of vertebrae mostly got involved, and the intervertebral space stenosis was often less than the normal 1/2. Four vertebra were involved in tuberculosis group, and the incidence of thoracolumbar vertebrae was the highest. And then, the anterior, middle and posterior parts of vertebrae were involved. The intervertebral space stenosis was often greater than normal 1/2. There were significantly statistical differences in the range of vertebral body involved, intervertebral space stenosis(less than 1/2), and lesions of thoracolumbar vertebrae and lumbosacral vertebrae in the two groups(P<0.05). The top three MRI signs of brucellosis group were vertebral body without flattening, intervertebral disc involvement and paravertebral abscess, respectively. On the other hand, the top three MRI signs of tuberculosis group were intervertebral disc involvement, paravertebral abscess and spinal stenosis, respectively. There were significant differences in intervertebral disc involvement, paravertebral abscess with spinal stenosis, psoas major abscess with paravertebral abscess, psoas major abscess with paravertebral abscess, psoas major abscess with spinal stenosis, vertebral body without flattening, peripheral muscle edema and spinal cord edema between the two groups(P<0.05). Conclusion The multi-segmental brucella spondylitis and tuberculous spondylitis have different clinical symptoms and MRI characteristics. Therefore, comprehensive analysis is helpful for early differential diagnosis,guidance of treatment, and avoidance of misdiagnosis or waiting for the results of the examination which aggravates the patient's condition.
引文
[1] 王杉,钱丽霞.布氏杆菌性脊柱炎与脊柱结核的磁共振成像特征对比分析[J].中国药物与临床,2014,14(7):934-935.
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[3] Turan H,Serefhanoglu K,Karadeli E,et al.Osteoarticular involvement among 202 brucellosis cases identified in Central Anatolia region of Turkey[J].Intern Med,2011,50(5):421-428.
[4] 蒋雯,孙建华,曹城彰,等.布鲁菌病性脊柱炎误诊为脊柱结核12例分析[J].临床误诊误治,2017,30(6):4-6.
[5] 何长林.MRI在布氏杆菌脊柱炎和脊柱结核鉴别诊断中的应用价值[J].医学临床研究,2017,34(1):64-67.
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[7] Lim K B,Kwak Y G,Kim D Y,et al.Back pain secondary to Brucella spondylitis in the lumbar region[J].Ann Rehabil Med,2012,36(2):282-286.
[8] 刘志,杨东奎.慢性布氏杆菌性脊椎病影像学分析[J].中华临床医师杂志(电子版),2010,4(5):681-682.
[9] Bozgeyik Z,Aglamis S,Bozdag P G,et al.Magnetic resonance imaging findings of musculoskeletal brucellosis[J].Clin Imaging,2014,38(5):719-723.
[10] 杨新明,石蔚,杜雅坤,等.布氏杆菌性脊柱炎与脊椎结核临床影像学表现比较[J].临床放射学杂志,2008,27(2):231-234.
[11] 张超,路坦.脊柱结核与脊柱炎的MRI影像鉴别价值研究[J].中国CT和MRI杂志,2016,14(7):115-117.
[12] 袁雁,徐慧,楼俭茹.布氏杆菌性脊柱炎与脊柱结核的影像特征差异分析[J].新疆医科大学学报,2016,39(9):1115-1118.
[13] Giannitsioti E,Papadopoulos A,Nikou P,et al.Long-term triple-antibiotic treatment against brucellar vertebral osteomyelitis[J].Int J Antimicrob Agents,2012,40(1):91-93.
[14] Lebre A,Velez J,Seixas D,et al.Brucellar spondylodiscitis:case series of the last 25 years[J].Acta Med Port,2014,27(2):204-210.
[15] Gao Q,Du Q,Zhang H,et al.Monocyte chemotactic protein-1-2518 gene polymorphism and susceptibility to spinal tuberculosis[J].Arch Med Res,2014,45(2):183-187.
[16] 郑龙嵋,周和平,朱亚男,等.布鲁菌病脊柱炎与脊柱结核的MRI表现及鉴别[J].现代医用影像学,2014,23(4):339-341.
[17] 姚晓龙,李白艳.MRI在儿童脊柱结核诊断中的应用[J].中国防痨杂志,2015,37(10):1067-1069.
[18] Thammaroj J,Kitkhuandee A,Sawanyawisuth K,et al.MR findings in spinal tuberculosis in an endemic country[J].J Med Imaging Radiat Oncol,2014,58(3):267-276.
[19] 司东雷,王书行,赵晖,等.布氏杆菌性脊柱炎在低场MRI的表现分析[J].中国中西医结合影像学杂志,2011,9(4):306-308.
[20] 王云钊,梁碧玲.中华影像医学骨肌系统卷[M].北京:人民卫生出版社,2012:320-340.
[21] Pina M A,Modrego P J,Uroz J J,et al.Brucellar spinal epidural abscess of cervical location:report of four cases[J].Eur Neurol,2001,45(4):249-253.
[22] Garg R K,Somvanshi D S.Spinal tuberculosis:a review[J].J Spinal Cord Med,2011,34(5):440-454.
[23] 郝志强,刘志斌.脊柱结核外科诊疗进展[J].中华临床医师杂志(电子版),2013,7(15):7135-7137.
[24] Yang X M,Shi X,Meng X Y,et al.The assessment of the clinical effect of the drug compatibility and course of treatment to the brucella spondylitis[J].Surgical Science,2013,4(1):92-99.
[25] Rigotti S,Zorzi C.The importance of early diagnosis with magnetic resonance imaging in spinal tuberculosis[J].J Neurosci Rural Pract,2013,4(2):119.
[2] 于天松,刘玉春,袁晨,等.布鲁菌性脊柱炎与脊柱结核MRI表现[J].实用放射学杂志,2010,26(7):1066-1067,1074.
[3] Turan H,Serefhanoglu K,Karadeli E,et al.Osteoarticular involvement among 202 brucellosis cases identified in Central Anatolia region of Turkey[J].Intern Med,2011,50(5):421-428.
[4] 蒋雯,孙建华,曹城彰,等.布鲁菌病性脊柱炎误诊为脊柱结核12例分析[J].临床误诊误治,2017,30(6):4-6.
[5] 何长林.MRI在布氏杆菌脊柱炎和脊柱结核鉴别诊断中的应用价值[J].医学临床研究,2017,34(1):64-67.
[6] 李宏军.实用传染病影像学[M].北京:人民卫生出版社,2014:719-721.
[7] Lim K B,Kwak Y G,Kim D Y,et al.Back pain secondary to Brucella spondylitis in the lumbar region[J].Ann Rehabil Med,2012,36(2):282-286.
[8] 刘志,杨东奎.慢性布氏杆菌性脊椎病影像学分析[J].中华临床医师杂志(电子版),2010,4(5):681-682.
[9] Bozgeyik Z,Aglamis S,Bozdag P G,et al.Magnetic resonance imaging findings of musculoskeletal brucellosis[J].Clin Imaging,2014,38(5):719-723.
[10] 杨新明,石蔚,杜雅坤,等.布氏杆菌性脊柱炎与脊椎结核临床影像学表现比较[J].临床放射学杂志,2008,27(2):231-234.
[11] 张超,路坦.脊柱结核与脊柱炎的MRI影像鉴别价值研究[J].中国CT和MRI杂志,2016,14(7):115-117.
[12] 袁雁,徐慧,楼俭茹.布氏杆菌性脊柱炎与脊柱结核的影像特征差异分析[J].新疆医科大学学报,2016,39(9):1115-1118.
[13] Giannitsioti E,Papadopoulos A,Nikou P,et al.Long-term triple-antibiotic treatment against brucellar vertebral osteomyelitis[J].Int J Antimicrob Agents,2012,40(1):91-93.
[14] Lebre A,Velez J,Seixas D,et al.Brucellar spondylodiscitis:case series of the last 25 years[J].Acta Med Port,2014,27(2):204-210.
[15] Gao Q,Du Q,Zhang H,et al.Monocyte chemotactic protein-1-2518 gene polymorphism and susceptibility to spinal tuberculosis[J].Arch Med Res,2014,45(2):183-187.
[16] 郑龙嵋,周和平,朱亚男,等.布鲁菌病脊柱炎与脊柱结核的MRI表现及鉴别[J].现代医用影像学,2014,23(4):339-341.
[17] 姚晓龙,李白艳.MRI在儿童脊柱结核诊断中的应用[J].中国防痨杂志,2015,37(10):1067-1069.
[18] Thammaroj J,Kitkhuandee A,Sawanyawisuth K,et al.MR findings in spinal tuberculosis in an endemic country[J].J Med Imaging Radiat Oncol,2014,58(3):267-276.
[19] 司东雷,王书行,赵晖,等.布氏杆菌性脊柱炎在低场MRI的表现分析[J].中国中西医结合影像学杂志,2011,9(4):306-308.
[20] 王云钊,梁碧玲.中华影像医学骨肌系统卷[M].北京:人民卫生出版社,2012:320-340.
[21] Pina M A,Modrego P J,Uroz J J,et al.Brucellar spinal epidural abscess of cervical location:report of four cases[J].Eur Neurol,2001,45(4):249-253.
[22] Garg R K,Somvanshi D S.Spinal tuberculosis:a review[J].J Spinal Cord Med,2011,34(5):440-454.
[23] 郝志强,刘志斌.脊柱结核外科诊疗进展[J].中华临床医师杂志(电子版),2013,7(15):7135-7137.
[24] Yang X M,Shi X,Meng X Y,et al.The assessment of the clinical effect of the drug compatibility and course of treatment to the brucella spondylitis[J].Surgical Science,2013,4(1):92-99.
[25] Rigotti S,Zorzi C.The importance of early diagnosis with magnetic resonance imaging in spinal tuberculosis[J].J Neurosci Rural Pract,2013,4(2):119.