目的 通过探讨和明确布鲁氏杆菌病性脊柱炎的影像学特点,从影像学角度增强对该病的认识和诊断,以降低误诊率.方法 回顾性分析2010年1月至2017年1月我科收治的72例布鲁氏杆菌病性脊柱炎病人的影像学资料(X线、CT及MRI片),所有病人均经实验室、病理检查明确诊断.其中男53例,女19例;年龄为30~77岁,平均52.0岁.本组病人均有疫区或病原菌接触史,45例(62.5%)从事畜牧养殖业,22例(30.6%)从事牛羊肉屠宰加工,5例(6.9%)居住在布鲁氏杆菌病的流行区.病人由影像学专业医生及脊柱外科医生共同确定其影像学表现及诊断要点,三种影像学检查均同期进行(CT和MRI间隔不超过15 d):常规摄正侧位X线片,CT检查采用Philips 16层螺旋CT扫描,MRI检查采用Phil-ips 0.5 T和Siemens 1.5 T MRI仪(脊柱专用线圈).结果 本研究影像学特点:①X线片主要表现为椎间隙高度的改变以及侧方骨赘的形成,以及骨质破坏;本组病例以腰骶椎(56例/77.8%)最为常见,其次为颈椎6例(8.3%)、胸椎5例(6.9%),多节段混合椎体受累为5例(6.9%).②CT检查显示布鲁氏杆菌病性脊柱炎早期表现为溶骨性破坏(终板及椎体片状溶骨),一般为多个椎体受累,中后期以椎体边缘骨赘及骨桥形成、终板硬化及椎体出现成骨为主要特征;出现终板片状溶骨54例(75.0%),出现椎体片状溶骨37例(51.4%),出现边缘骨赘59例(81.9%),骨桥形成有10例(13.9%),椎板硬化25例(34.7%),椎体有成骨17例(23.6%).③MRI检查发现早期T1WI椎体(67例/93.1%)和椎间盘(57例/79.2%)主要表现为低信号,T2WI椎体(40例/55.6%)和椎间盘(64例/88.9%)则主要表现为高信号,压脂相中椎体(68例/94.4%)及椎间盘(64例/88.9%)为高信号,此外该病常见椎旁软组织影(40例/55.6%)和硬膜前肉芽肿(26例/36.1%),椎旁脓肿较少见.结论 布鲁氏杆菌病性脊柱炎的X线、CT以及MRI检查的表现具有其自身的特点和表现,结合流行病学特点及实验室检查可明确诊断,减少误诊发生率.%Objective To explore and clarify the imaging features of Brucella spondylitis, enhance understanding and diagnosis of the disease from the imaging point of view so as to reduce misdiagnosis. Methods The imaging data (X-ray, CT and MRI) of 72 Brucella spondylitis patients from January 2010 to January 2017 were retrospectively analyzed, and the diagnosis was made by lab and pathological examinations. The patients consisted of 53 males and 19 females, aged 30 to 77, 52.0 on the average. All of them had exposed to infected areas or pathogens, 45 (62.5%) engaged in animal husbandry, 22 (30.6%) engaged in cattle and sheep slaughtering, and 5 (6.9%) living in Brucellosis epidemic areas. The imaging manifestations and the main points of diagnosis were jointly determined by imaging specialists and spinal surgeons, and 3 imaging examinations were performed concurrently (interval between CT and MRI not more than 15 days): X-ray film conventional anterior-posterior and lateral, CT examination by Philips 16 spiral CT scanning, MRI examination by Philips 0.5 T and Simens 1.5 T magnetic resonance imaging instrument, and dedicated spinal coil. Results The imaging features:①X-ray films showed some change in inter-vertebral space height and formation of lateral osteophytes, and bone destruction, successively common as lumbosacral vertebrae (56 cases, 77.8%), cervical spine (6 cases, 8.3%), thoracic spine (5 cases, 6.9%), and multi-segmental mixed vertebral involvement (5 cases, 6.9%). ②CT examination showed osteolytic destruction as early Brucella spondylitis (endplate and vertebral lamellar osteolysis), usually multiple vertebral involvement, mid and late periods characterized by vertebral margin osteophyte and bone bridge, endplate sclerosis and vertebral osteosynthesis, witnessing 54 cases (75%) of endplate lamellar osteolysis, 37 cases (51.4%) of vertebral lamellar osteolysis, 59 cases (81.9%) of margin osteophyte, 10 cases (13.9%) of bone bridge, 25 cases (34.7%) of vertebral lamina sclerosis and 17 cases (23.6%) of vertebral osteosynthesis.③MRI examination showed early T1WI vertebral and inter-vertebral different low signals, and occasional iso-signals, T2WI iso-signals or high signals, T2WI-FS vertebral and inter-vertebral high signals, furthermore, common vertebral soft tissues, and rare paravertebral abscess. Conclusion X-ray, CT and MRI examinations of Brucella spondylitis all have their own characteristics and manifestations. It is proper for diagnosis in combination with the characteristics of epidemiology and lab tests, reducing misdiagnosis.
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