MRI及病理学在鉴别早期脊柱炎症中的应用及价值
发布时间：2018-10-08 06:48
【摘要】：研究背景 在国内,由于抗生素的广泛使用,典型化脓性脊柱炎病例已较少见,增加了早期诊断的困难。布氏杆菌病为人畜共患传染病,其病变过程脊柱容易受侵犯进而发展成为布氏杆菌脊柱炎。结核病虽然常发生于呼吸系统,但骨关节结核并不罕见,脊柱为其最好发位置,占骨关节结核总数的50%。早期脊柱炎症在影像学及临床表现上有诸多类似之处,然而三者的治疗却完全不同。因此正确的早期诊断及鉴别诊断,及时有效的干预治疗,能够明显减少患者脊柱畸形与功能损害的概率。如今,病理学检测已作为常规检查手段在临床中应用,MRI因其精确的显示、多维显像以及较好的软组织分辨率是脊柱炎症的首选检查方法。为此,作者拟通过观察病理组织显微特点与MRI征象改变,探讨病理学及MRI在早期脊柱炎症鉴别诊断中的价值。 目的 通过观察脊柱炎症病理结果与MRI征象改变,探讨病理学及MRI在早期脊柱炎症鉴别诊断中的应用价值。 方法 对22例化脓性脊柱炎、20例布氏杆菌脊柱炎、20例脊柱结核患者行CT引导下经皮穿刺椎体活检及MRI检查,病理学切片观察结果包括病变骨组织结构及活力,组织细胞及其主要成分；MRI观察结果包括病变部位、信号改变及征象变化。比较分析3组患者病理及MRI检查结果的构成比,统计方法为卡方检验。 结果 下列结果中,化脓性脊柱炎组总体率最高,且差异有显著性意义(P0.05)：嗜中性粒细胞浸润为主；椎间盘明显异常信号,椎体病变位置椎体前+后方,脓肿壁厚而不规则；下列结果中,布氏杆菌脊柱炎组总体率最高,且差异有显著性意义(P0.05)：淋巴细胞浸润为主,新生骨组织,类上皮样肉芽肿组织,椎体病变位置椎体前方,椎体形态无明显变化,椎旁软组织无明显异常信号,无骨内或椎旁脓肿形成,脓肿壁薄而不规则；下列结果中,脊柱结核组总体率最高,且差异有显著性意义(P0.05)：死骨组织,朗格汉斯巨细胞,干酪样坏死,病变部位位于下胸椎,椎间盘无明显异常信号,椎体后方病变,病变椎体形态明显变化,椎旁软组织明显异常信号,骨内或椎旁脓肿形成,脓肿壁薄而光滑。 结论 通过对三种早期脊柱炎症的病理学及MRI征象描述及比较,提示病理学及MRI在早期脊柱炎症的鉴别诊断中具有较高价值。该鉴别思路对细菌培养阴性脊柱炎症患者的诊断更有帮助。
[Abstract]:Background due to the widespread use of antibiotics, typical suppurative spondylitis cases have been rare in China, increasing the difficulty of early diagnosis. Brucellosis is a zoonotic disease. Although tuberculosis often occurs in the respiratory system, osteoarticular tuberculosis is not uncommon, the spine is the best location, accounting for 50% of the total bone and joint tuberculosis. Early spinal inflammation has many similarities in imaging and clinical manifestations, but the treatment of the three is completely different. Therefore, correct early diagnosis and differential diagnosis, timely and effective intervention can significantly reduce the probability of spinal deformity and functional damage. Nowadays, pathological examination has been used as a routine examination method in clinic because of its accurate display, multi-dimensional imaging and better soft tissue resolution, it is the preferred examination method for spondylitis. Therefore, the authors intend to investigate the value of histopathology and MRI in the differential diagnosis of early spinal inflammation by observing the histopathological features and the changes of MRI signs. Objective to investigate the value of pathology and MRI in the differential diagnosis of early spinal inflammation by observing the pathological results of spinal inflammation and the changes of MRI signs. Methods 22 cases of suppurative spondylitis and 20 cases of brucellae spondylitis and 20 cases of spinal tuberculosis were examined by CT guided percutaneous vertebra biopsy and MRI examination. MRI findings of histocyte and its main components include lesion location, signal changes and signs. The results of pathological and MRI examination were compared and analyzed in three groups. The statistical method was chi-square test. Results among the following results, the total rate of suppurative spondylitis was the highest, and the difference was significant (P0.05): neutrophilic granulocyte infiltration was dominant; The abscess wall was thick and irregular. The overall rate of Brucella spondylitis group was the highest, and the difference was significant (P0.05): lymphocytic infiltration, new bone tissue, epithelioid granulomatous tissue, anterior vertebral body lesion, There was no obvious change in the shape of vertebral body, no obvious abnormal signal in the paravertebral soft tissue, no intraosseous or paravertebral abscess, and the abscess wall was thin and irregular. Among the following results, the total rate of spinal tuberculosis group was the highest, and the difference was significant (P0.05): dead bone tissue, Langerhans giant cells, caseous necrosis, lesions located in the lower thoracic vertebrae, no obvious abnormal signal in the intervertebral disc, pathological changes in the posterior vertebral body, obvious changes in the shape of the lesion vertebrae, abnormal signals in the soft tissue around the vertebrae, intraosseous or paravertebral abscess, The wall of the abscess is thin and smooth. Conclusion through the description and comparison of pathological and MRI signs of three kinds of early spondylitis, it is suggested that pathology and MRI have higher value in differential diagnosis of early spondylitis. This method is helpful for the diagnosis of bacterial culture negative spondylitis.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R681.5;R445.2
本文编号：2255830
[Abstract]:Background due to the widespread use of antibiotics, typical suppurative spondylitis cases have been rare in China, increasing the difficulty of early diagnosis. Brucellosis is a zoonotic disease. Although tuberculosis often occurs in the respiratory system, osteoarticular tuberculosis is not uncommon, the spine is the best location, accounting for 50% of the total bone and joint tuberculosis. Early spinal inflammation has many similarities in imaging and clinical manifestations, but the treatment of the three is completely different. Therefore, correct early diagnosis and differential diagnosis, timely and effective intervention can significantly reduce the probability of spinal deformity and functional damage. Nowadays, pathological examination has been used as a routine examination method in clinic because of its accurate display, multi-dimensional imaging and better soft tissue resolution, it is the preferred examination method for spondylitis. Therefore, the authors intend to investigate the value of histopathology and MRI in the differential diagnosis of early spinal inflammation by observing the histopathological features and the changes of MRI signs. Objective to investigate the value of pathology and MRI in the differential diagnosis of early spinal inflammation by observing the pathological results of spinal inflammation and the changes of MRI signs. Methods 22 cases of suppurative spondylitis and 20 cases of brucellae spondylitis and 20 cases of spinal tuberculosis were examined by CT guided percutaneous vertebra biopsy and MRI examination. MRI findings of histocyte and its main components include lesion location, signal changes and signs. The results of pathological and MRI examination were compared and analyzed in three groups. The statistical method was chi-square test. Results among the following results, the total rate of suppurative spondylitis was the highest, and the difference was significant (P0.05): neutrophilic granulocyte infiltration was dominant; The abscess wall was thick and irregular. The overall rate of Brucella spondylitis group was the highest, and the difference was significant (P0.05): lymphocytic infiltration, new bone tissue, epithelioid granulomatous tissue, anterior vertebral body lesion, There was no obvious change in the shape of vertebral body, no obvious abnormal signal in the paravertebral soft tissue, no intraosseous or paravertebral abscess, and the abscess wall was thin and irregular. Among the following results, the total rate of spinal tuberculosis group was the highest, and the difference was significant (P0.05): dead bone tissue, Langerhans giant cells, caseous necrosis, lesions located in the lower thoracic vertebrae, no obvious abnormal signal in the intervertebral disc, pathological changes in the posterior vertebral body, obvious changes in the shape of the lesion vertebrae, abnormal signals in the soft tissue around the vertebrae, intraosseous or paravertebral abscess, The wall of the abscess is thin and smooth. Conclusion through the description and comparison of pathological and MRI signs of three kinds of early spondylitis, it is suggested that pathology and MRI have higher value in differential diagnosis of early spondylitis. This method is helpful for the diagnosis of bacterial culture negative spondylitis.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R681.5;R445.2
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