结核性脊柱炎的MRI表现及与CT的对比研究

发布时间：2019-06-03 10:58

【摘要】：目的：探讨脊柱结核的MRI表现特点以及对病灶本身细节进行量化；对比CT平扫、CT重建、MRI影像学检查手段对脊柱结核病灶显示的优势及其在指导诊断治疗中的应用。方法：回顾性分析佛山市中医院2009.02.16-2013.01.30期间收治的共39例经手术和病理证实的脊柱结核的影像资料。观察患者MRI图像,采用德国Siemens1.5T Magnetom Avanto磁共振成像仪,用脊椎专用线圈。常规矢状面T1WI、T2WI,轴位和冠状面T2WI,静脉注射Gd-DTPA后增强扫描采用T1WI或脂肪抑制T1WI序列。28例同期行CT检查,采用Philip Mx8000IDT16排螺旋CT,层厚2mm,层距1mm,检查包括所有病变椎体及上下相邻椎体,骨窗和软组织窗显示图像。采用Philip4.3后处理工作站处理CT重建图像。在椎体病变、椎间盘病变、椎管改变、椎旁脓肿等方面进行影像评估测量,并对评估值进行细致量化。将CT平扫、CT重建、MRI影像学检查手段对脊柱结核病灶显示进行评分并作统计学分析,对比其各自优势。成果： 39例接受检查的病患中累及颈椎1例,胸椎16例,累及胸腰椎8例,腰椎13例,骶椎1例；同期行CT和MRI两种影像检查手段的28例病患中,累及胸椎的占28.6%,腰椎的占50%,累及胸腰椎的占2I.4%。除1例单椎体受累外,其余38例病患均有两个或两个以上椎体受累,其中两个椎体受累24例,三个及以上14例(最常累及T5-L1)。本组样本CT平扫、CT重建(MPR)和MRI显示脊柱结核病变的敏感性分别为76%、86%和100%。应用四格表卡方检验比较,结果表明CT与MRI之间X2=22.703,p0.05,差异具统计学意义；CT与MPR之间X2=3.204,p中0.05,差异不具统计学意义：MPR与MRI之间X2=11.771,p0.05,差异具统计学意义。因此脊柱结核的显示敏感性MRI比CT、MPR好。此外,在显示椎体破坏方面, MPR、MRI较之CT有优势,MPR和MRI对比差异不显著；在显示椎间盘病变、椎管改变、椎旁脓肿方面,MRI较之CT、MPR更有优势；而在判断骨硬化、死骨形成、脓肿及软组织钙化方而,CT、MPR较之MRI优势显著。对比各种医学影像学手段,MRI的优势明显,一是其软组织对比分辨率最高,它可以清楚地分辨脊柱周围肌肉、肌腱、筋膜、脂肪、脓肿等软组织,可全面显示脊柱结构并直接做出横断面、失状面、冠状而和各种斜面的体层图像,以便进行解剖结构或病变的立体追踪。二是MRI成像参数多,包含信息量大,MRI的成像潜力巨大,为临床应用提供广阔的研究领域。三是MRI显示疾病的病理过程较广泛,常常能更有效和更早地发现病变,它能非常清晰地显示脊髓的灰质和白质,不受骨像干扰,故在脊柱神经系统病变方面有较高的诊断价值。因此,MRI较之CT和MPR在显示椎间盘病变、椎管改变、椎旁脓肿方面的显著优势；在显示这些骨组织退变后的改变对脊髓神经根的压迫方面,MRI亦优于CT。然而钙化灶内不含质子,不产生MR[信号,故MRI对钙化不敏感,小钙化灶由于容积效应不能显示,大的钙化灶表现为无信号区亦缺乏特异性。钙化在发现病变和定性诊断上有帮助,所以在这方面CT和MPR则体现了其优势,在观察颈椎骨刺、韧带钙化及椎管狭窄等骨组织的退变情况时,优于MRI。此外,MPR能将扫描范围内所有的轴位图像叠加起来,再对某些标线标定的重组线所指定的组织进行冠状、矢状位、任意角度斜位图像重组。MPR的优点主要体现在三个方面：一是能任意产生新的断层图像,而无需重复扫描；二是原图像的密度值被忠实保持到结果图像上；三是曲面重组能在一幅图像里展开显示弯曲物体的全长。因此在检查脊椎时,往往轴切面的影像只限于有时才能显出椎体,也无法完全显示出椎间盘,而应用MPR使我们可以更容易观察出脊椎的位置以及其和其他器官的关系；这从技术的层而解释了CT与MPR在统计结果里显示的椎间盘改变特征差异化的原因。同时,MPR的缺点则体现在难以表达复杂的空间结构和曲面重组易造成假阳性两个方面,我们也可以据此解释MPR与MRI在后突畸形特征方面的无差异统计结果。结论： (1)脊柱结核的影像学表现与其病理变化是相关联的；对于CT平扫、CT重建不明显的早期病变,MRI即可清晰显示其出现的受累脊椎及椎旁软组织信号改变等情况。(2)结核性脊柱炎的典型CT平扫、CT重建表现为：椎体破坏且始于椎体边缘、死骨形成、局限性溶骨、椎旁脓肿壁及软组织钙化,较严重病例可累及肋骨。结核性脊柱炎的典型MRI表现为：椎体破坏、椎体或后部附件均可单独受累(较严重病例可累及肋骨)、椎间盘改变、椎旁软组织影及硬膜囊和脊髓改变。腰大肌脓肿及软组织钙化可作为诊断结核性脊柱炎的影像线索。椎(?)脓肿的大小与椎体破坏程度或临床症状程度不成比例。CT平扫、CT重建能较好地显示出脊柱结核的破坏范围以及其细微钙化,而MRI则很好地显示出脊柱结核的侵犯范围以及所有组织病变。(3)不同影像学手段对脊柱结核病灶显示各具优势,不能完全相互替代,需将这些检查相互结合才能提高脊柱结核的诊断,对临床制定治疗方案具有重要的参考价仇。
[Abstract]:Purpose: To study the MRI features of spinal tuberculosis and to quantify the details of the focus, and to compare the advantages of CT, CT, MRI and MRI in the diagnosis and treatment of spinal tuberculosis. For use. Methods: A total of 39 cases of spinal tuberculosis confirmed by operation and pathology were analyzed retrospectively. The image data of the patient was observed. The MRI image of the patient was observed, using a German Siemens 1. 5T Magnetom Avanto magnetic resonance imager and a ridge. T1WI, T2WI, axial and coronal T2WI, and Gd-DTPA enhanced scan were performed with T1WI or fat to inhibit the T1WI sequence. The CT of 28 patients was performed in the same period. The CT was performed with Philip Mx8000IDT16, with a layer thickness of 2 mm and a layer interval of 1 mm. The examination included all the diseased vertebral bodies and the upper part. Lower adjacent vertebral body, bone window and soft tissue Window display image. Process C using the Philip 4.3 post-processing workstation The image was reconstructed in the aspects of vertebral body lesion, disc lesion, spinal canal change, and paravertebral abscess. The CT plain scan, CT reconstruction and MRI imaging examination were used to score and compare the display of the spinal tuberculosis. each of which The results:1 case of cervical vertebra,16 cases of thoracic vertebra,8 cases of thoracic and lumbar vertebra,13 cases of lumbar vertebra and 1 case of cervical vertebra were involved in 39 cases of examination. % of the lumbar,50% of the lumbar spine, involving the chest The lumbar vertebrae accounted for 2I.4%. In addition to one single vertebral body involvement, the remaining 38 patients had two or more vertebral body involvement, including 24 cases, three or more 14 cases (most The sensitivity of CT plain scan, CT reconstruction (MPR) and MRI in the diagnosis of spinal tuberculosis was 7. The results showed that X2 = 22.703, p0.05 in CT and MRI, and the difference was not significant between CT and MPR: X2 = 11.771, p0 between MPR and MRI. 05. The difference is of statistical significance. Therefore, the display sensitivity of spinal tuberculosis The MRI is better than CT and MPR. In addition, in the aspect of displaying the destruction of the vertebral body, the MPR and MRI have the advantages of comparing with the CT, and the contrast between the MPR and the MRI is not significant; in the aspect of displaying the disc lesion, the spinal canal change and the paravertebral abscess, the MRI is more advantageous than the CT and the MPR; and in the judgment of the bone hardening, the forming of the dead bone , Abscess and Soft Tissue Calcification, CT, M Compared with MRI, the advantage of MRI is that the contrast resolution of soft tissue is the highest, and it can clearly distinguish the soft tissue, such as muscle, tendon, fascia, fat, abscess and other soft tissues around the spinal column. a layer image that is configured and directly made in cross-section, out-of-form, coronal, and various inclined planes, so as to The second is the imaging parameters of the MRI, including the large amount of information, and the imaging potential of the MRI is huge. The third is that the pathological process of MRI shows that the pathological process of the disease is wide, it is often more effective and early to find the lesion, it can show the gray matter and the white matter of the spinal cord very clearly, and is not disturbed by the bone image, so it is in the spinal nerve system There is a high diagnostic value in the pathological aspect of the system. Therefore, the MRI is superior to that of the CT and MPR in the display of the disc lesion, the spinal canal changes and the paravertebral abscess, and the change of the bone tissue degeneration to the spinal nerve root after the degeneration of the bone tissue is shown. In the aspect of compression, MRI is also superior to CT. However, no proton is present in the calcified range, and MR[signal is not generated, so the MRI is not sensitive to calcification, and the small calcified range cannot be displayed due to the volume effect and large calcium There is also a lack of specificity in the signal-free area. Calcification is helpful in the discovery of lesions and qualitative diagnosis, so the CT and MPR in this respect reflect its advantages in the observation of the cervical spine, the calcification of the ligamentum and the spinal stenosis. In addition, MPR is superior to MRI in the case of the degeneration of bone tissue. In addition, the MPR can superpose all the axial images in the scan range, and then perform the coronary on the tissue designated by the recombinant line that is calibrated by some reticles. the advantages of the MPR are mainly embodied in three aspects: firstly, a new fault image can be arbitrarily generated without repeated scanning; secondly, the density value of the original image is faithfully kept on the result image; and thirdly, the surface recombination can be carried out in one step, The full length of the curved object is displayed in the image. Therefore, in the examination of the spine, the image of the axial section is limited to sometimes the vertebral body, and the disc can not be fully displayed, and the application of MPR makes it easier to observe the ridge. The position of the vertebra, as well as its relationship with other organs; this explains the display of the CT and MPR in the statistical results from the layer of the technique At the same time, the defect of MPR is that it is difficult to express the complex spatial structure and the surface recombination is easy to cause false positive two aspects, and we can also explain the MPR and MRI at the same time deformity of process Conclusion: (1) The imaging performance of spinal tuberculosis is associated with its pathological changes. The typical CT and CT reconstruction of the tuberculous spondylitis showed that the vertebral body was damaged and started at the edge of the vertebral body, the formation of the dead bone, the limitation of the osteolytic bone and the paravertebral pus. Calcification of the wall and soft tissue, the more serious case may involve the rib. The typical MRI of the tuberculous spondylitis is: the vertebral body is damaged, the vertebral body or the posterior accessory can be affected separately (the more serious case may involve the rib), the intervertebral body Changes of disc, paravertebral soft tissue and subdural sac and spinal cord changes. Abscess of the lumbar muscle and soft group Calcification can As an image clue to the diagnosis of tuberculous spondylitis, the size of the abscess of the vertebra (?) Small to the degree of destruction of the vertebral body or to the degree of clinical symptoms. CT scanning and CT reconstruction can well show the extent of the destruction of the spinal tuberculosis and the fine calcification of the spinal tuberculosis, and the MRI is very good. The scope of the invasion and all the pathological changes of the spinal tuberculosis are shown. (3) The different imaging methods have different advantages to the spinal tuberculosis range, which can not be replaced completely, and the examination should be combined to improve the diagnosis of spinal tuberculosis.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R274.9;R445.2;R816.8

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