脊柱结核的MRI表现

摘要

Objective To explore the MRI features of spinal tuberculosis and analyze the characteristics of spinal tuberculosis. Methods The MRI feactures of 44 cases with spinal tuberculosis diagnosed by surgery and pathology were collected and retrospectively analyzed. The signals of vertebrae, end-plates, intervertebral discs and abscess at every sequence and enhanced scanning were observed. Results (1) A total of 110 vertebrates were involved in 44 patients. Two of 44 cases had only one vertebrate involved, 30 cases had two vertebrates involved, and 12 cases had more than 3 vertebrates involved. T1WI showed hypointense and mixed hypointense, and T2WI and T2WI+STIR showed hyperintense and mixed hyperintense. The end-plate was limitedly destructed, with small cystiform abcess seen, presenting long structure-less T1/T2 signal. (2) Single spinal discs has pathological changes in 39 cases. T1WI showed low signal intensity, and T2W1+STIR showed mixed high signal intensity. 5 cases had normal spinal discs. (3) All the 44 cases showed swelling vertebral soft tissue (across more than two vertebral body), and 39 cases showed "cold abscess" around vertebrates. Ten of the 39 cases showed abscess in psoas major muscle and 4 showed abscess in vertebrate cavity. The abscess showed low signal intensity on T1WI and hyperintense on T2WI and T2W1+STIR. Enhanced scanning showed ribbon or circular enhancement. (4) 15 patients showed abnormal signal in 21 vertebral arches. And spinal cords were pressed in 18 patients. Conclusion Damage of vertebrates and discs as well as destruction of vertebrates with "cold abscess" around vertebrates are the characteristics of spinal tuberculosis. MRI can detect the early features of spinal tuberculosis and exhibit the pathological changes.%目的 探讨脊柱结核的MRI表现,分析其特征.方法 回顾分析44例经手术病理证实的脊柱结核MRI征象,观察椎体、终板、椎间盘、冷脓疡的信号变化和增强后改变.结果 (1)44例共有110个椎体受累,单椎体2例,2个椎体30例,3个及以上椎体12例；椎体破坏于T1WI呈片状均匀低信号、混杂信号,T2WI及T2脂肪抑制序列呈均匀高信号、混杂信号；终板局限破坏,见囊状小脓肿形成,呈无结构长T1、长T2信号.(2) 39例为单个椎间盘受累,其中轻度变窄20例,中至重度变窄19例,T1WI呈低信号,T2WI及T2+STIR呈不均匀高信号,椎间盘正常者5例.(3) 44例椎旁软组织肿胀,椎前或椎旁脓肿39例,其中,10例伴腰大肌脓肿,4例伴椎管内脓肿.脓肿呈T1WI稍低、T2WI及T2+STIR明显高信号.增强扫描,脓肿壁呈不均匀条带状或环形强化.(4)15例患者21个椎弓根受累,18例脊髓受压.结论 椎体及椎间盘破坏、椎体破坏伴椎旁脓肿为脊柱结核特征,MRI能发现脊柱结核早期征象,反映其病理变化.