193例脊椎结核的MRI表现分析

目的 分析脊柱结核的各种MRI表现特点,探讨MRI的诊断价值,以提高对该病的诊断水平。 方法 回顾性分析2009年9月至2013年5月在首都医科大学附属北京胸科医院行MRI检查,并经组织病理学或细菌学证实的脊柱结核患者193例,男113例,女80例,年龄范围5～87岁,平均（47±15.1）岁。分析患者病变部位与数目,观察患者椎体形态、椎间盘、椎旁脓肿、硬膜囊及脊髓受压等变化的MRI征象。 结果 193例脊柱结核患者,共525个椎体受累,其中单独累及腰椎者所占比例最高,为95例（49.2%,95/193）,单独累及胸椎者54例（28.0%,54/193）;胸腰椎及腰骶椎同时受累者各13例（均占6.7%,13/193）,单独累及颈椎者8例（4.1%,8/193）,颈胸椎同时受累者4例（2.1%,4/193）,单独累及骶椎者、胸腰骶椎和颈腰椎同时受累者各2例（均占1.0%,2/193）。每例患者累及椎体个数为1～9个,其中2个椎体受累患者最多见,共114例（59.1%,114/193）。MRI征象中,椎体形态改变者189例（97.9%,189/193）,椎间盘受累172例（89.1%,172/193）,182例（94.3%,182/193）可见椎旁脓肿影,硬膜囊及脊髓受压138例（71.5%,138/193）,7例（3.6%,7/193）于T2WI可见脊髓异常高信号。 结论 MRI可清楚显示脊椎结核的椎体破坏、椎间盘信号的改变及椎旁脓肿范围,同时能明确硬膜囊受压情况和脊髓受累范围,对临床诊断和指导治疗有重要意义。     

老年人脊柱结核的影像表现特点

目的：分析老年人脊柱结核在放射影像上的表现特点。方法：26例老年脊柱结核患者全部进行了X线平片检查，9例CT检查，6例MRI检查，11例同时进行了CT和MRI检查；并与30例非老年脊柱结核患者的影像表现对比分析。结果：老年组均可见椎体骨质破坏和椎间隙变窄；20例CT检查，16例有椎旁脓肿形成，5例椎体内有小的高密度死骨；17例MRI检查，3例有明显椎旁脓肿，11例可见椎旁小脓肿形成。结论：老年人脊柱结核有时在影像上表现不典型，椎体骨质破坏主要位于靠近椎体终板处，一般累及相邻两个以上椎体和椎间盘，即使发现很小的椎旁脓肿也是结核病的重要诊断依据。     

MRI在脊柱结核诊断及鉴别诊断中的应用

目的探讨MRI在脊椎结核诊断及鉴别诊断中的应用价值。方法回顾性分析经手术及组织学证实的79例脊椎结核、肿瘤病例。结果45例脊椎结核MRI表现为椎体骨质破坏、碎裂、间盘受累、椎间隙变窄、椎旁可见软组织肿胀,椎体病变的信号改变,间盘病变及椎旁肿胀的信号均呈长T1、略长T2信号,STIR像为高信号。34例脊柱肿瘤椎间盘均未受累,其中15例转移瘤同时累及椎体及附件,2例累及附件。结论MRI在脊椎结核的诊断及鉴别诊断中具有明显的作用,特别是STIR成像显示更加清晰。     

脊柱结核患者 DR、CT、MRI影像表现对比分析

目的：对比分析脊柱结核的数字X线平片（ DR）、CT及MRI影像学特点,提高对脊柱结核的影像认识水平。方法16例脊柱结核患者均经手术病理或临床治疗随访证实,均先后行DR、CT和MRI检查。结果16例中,8例DR显示骨质病变及椎间隙狭窄或消失, CT则更清晰显示了椎体骨质病变,破坏程度及范围均较平片明显,12例CT均显示了不同程度的椎旁软组织密度影。16例MRI检查均显示了不同程度的软组织改变,其中9例椎间隙狭窄或者消失;3例平片及CT骨质破坏不明显, MRI示骨质明显信号异常。结论 DR为脊柱结核的基本检查方法,CT较好的显示了结核的破坏范围及细微钙化,MRI显示结核的侵犯范围、软组织异常及椎间盘异常有明显的优势,三者相结合优势互补,有助于脊柱结核的诊断。     

MRI对布鲁杆菌性脊椎炎的诊断价值分析

目的分析磁共振成像(MRI)对布鲁杆菌性脊椎炎的诊断价值。方法回顾分析28例布鲁杆菌性脊椎炎患者椎体与椎间盘受累信号、病发部位、椎管内外脓肿形成及扩散范围、破坏程度、诊疗情况等。结果 28例患者胸椎、骶椎各3例,颈椎1例,腰椎21例,分别占10.71%、3.57%、75.00%;T2WI高信号21例,T1WI低信号25例;椎间盘明显异常信号为35.71%,病变椎体形态变化明显为25.00%,椎旁软组织异常信号为35.71%,椎旁或骨内脓肿形成为25.00%,硬膜外有脓肿形成为10.71%,牵涉椎体≥3个为3.57%。结论 MRI对布鲁杆菌性脊椎炎具有较高鉴别诊断价值。     

布鲁菌性脊柱炎与脊柱结核临床影像学表现的对比

目的：分析与探讨布鲁菌性脊柱炎与脊柱结核不同的临床影像学特征,提高对布鲁菌性脊柱炎的影像学诊断水平。方法回顾性分析2011年1月至2013年12月,新疆医科大学附属中医医院收治的46例布鲁菌性脊柱炎患者的 X 线片、CT、MRI 影像学资料,与确诊的40例脊柱结核患者的影像学资料进行对比分析。结果布鲁菌性脊柱炎病灶分布于腰椎,其中以 L4患病率最高,骨破坏灶小而多发,多局限于椎体边缘,病灶周围明显增生、硬化,新生骨组织中有新破坏灶形成,椎间盘破坏轻,关节面增生硬化,相邻骨密度增高,少或无椎旁脓肿形成。结核病灶分布于胸腰段,以椎体和椎间盘骨破坏为主,并有死骨形成,椎旁脓肿和骨质疏松变化较常见。结论布鲁菌性脊柱炎和脊柱结核临床影像学特征性表现有助两者的鉴别诊断。     

84例颈椎结核患者影像学分析

目的 总结颈椎结核的影像学表现,为其诊断和治疗提供参考。 方法 回顾性分析2002年1月至2012年12月收治的84例颈椎结核患者的X线片、CT及MRI检查。对结核病变部位累及椎体数量及分布情况、椎体的改变情况（骨质破坏的方式、骨质缺损高度）、病变椎体的椎间隙改变情况等进行分析,同时对于椎管的改变和椎旁软组织的改变情况进行分析。对于颈椎生理弧度的变化,如存在后凸成角畸形,则测量其Cobb角的度数,通过Pearson相关分析（软件SPSS 19.0）研究Cobb角与病变椎体前缘骨质缺损高度、病程时间的相关性,并计算相关系数,以P〈0.05为差异有统计学意义。 结果 颈椎结核累及单个椎体者1例,占1.2%（1/84）;累及相邻2个椎体者63例,占75.0%（63/84）;累及3个及以上椎体者20例,占23.8%（20/84）;伴附件受累者13例,占15.5%（13/84）,未见附件单独受累。84例患者颈椎的生理弧度均有改变。其中64例颈椎生理前曲表现不同程度的减小,占76.2%（64/84）;20例颈椎或颈胸椎表现不同程度的后凸畸形,占23.8%（20/84）;后凸畸形患者Cobb角范围12°～82°,平均（29.0±19.6）°。Cobb角与病变椎体前缘骨质缺损高度、病程时间显著相关（r＝0.752～0.962,P〈0.01,差异具有统计学意义）。76例椎体有不同程度的骨质破坏,占90.5%（76/84）;8例椎体未见明显骨质破坏,仅MRI上有信号改变,占9.5%（8/84）。72例椎间隙有不同程度的狭窄,占85.7%（72/84）;12例椎间隙未见狭窄,占14.3%（12/84）。39例患者椎管变形,硬膜囊、神经根受压,占57.4%（39/68）;临床上伴有瘫痪症状者23例,占27.4%（23/84）,其中有12例病变累及颈胸段椎体（C7～T1）,占52.2%（12/23）。76例表现为椎旁软组织肿胀,占90.5%（76/84）,其中28例表现为单纯椎旁软组织肿胀,占36.8%（28/76）;48例脓肿形成,占63.2%（48/76）。 结论 影像学检查对于颈椎结核的诊断具有极为重要的意义,有助于明确病变侵及范围和程度,了解病变所致的颈椎形态变化,指导临床制订治疗规划。     

CT检查在脊柱结核中的临床应用

目的 评估CT对脊柱结核的诊断价值。方法 对80例脊柱结核病人的X线平片，CT片和手术进行对照分析。结果 CT较X线片诊断率分别提高：椎体骨质破坏提高27．5％，椎间盘破坏提高18．2％，死骨提高38．6％，脓肿提高29．2％，脊髓受压提高62．5％。平均提高35．2％。结论 它可提供精确的诊断依据，尤其在脊柱结核的早期诊断、手术指征、手术入路和有目的进行病灶清除具有重要指导价值。     

磁共振成像在布鲁氏菌性脊柱炎与脊柱结核的鉴别诊断价值

目的 探讨磁共振成像（MRI）在布鲁氏菌性脊柱炎与脊柱结核鉴别诊断中的应用价值,为布鲁氏菌性脊柱炎与脊柱结核的鉴别诊断提供参考依据。方法 选取广州市胸科医院及中山大学第一附属医院惠亚医院2019年1月到2021年12月期间收治的87例确诊脊柱结核患者作为脊柱结核组（广州市胸科医院87例）,23例确诊布鲁氏菌性脊柱炎患者作为脊柱炎组（广州市胸科医院5例,中山大学第一附属医院惠亚医院18例）,所有患者均行MRI检查,根据影像学资料比较两组的发病部位、椎体受累数、受累椎体信号形态特征、椎体破坏、椎间盘狭窄情况和脓肿信号。结果 两组的发病部位、椎体受累数对比无显著差异（P>0.05）。两组受累椎体信号形态特征对比差异有统计学意义（P <0.05）,其中脊柱炎组的弥散型信号比例(50.00%)低于脊柱结核组(88.89%),局灶型比例(30.43%)高于脊柱结核组(11.11%),扇形信号比例(23.08%)高于脊柱结核组(0)。两组椎体破坏和椎间盘狭窄情况比较差异有统计学意义(P <0.05),其中脊柱炎组的椎体塌陷比例(0)低于脊柱结核组(43.52%),脊柱后凸畸形比例(...     

椎体结核的CT表现分析

目的 分析总结椎体结核的CT表现，探讨CT对椎体结核的诊断价值。方法 对65例病人CT扫描结果进行分析。结果 在65例椎体结核中，52例骨质破坏，23例死骨形成，34例椎旁及腰大肌脓肿，儿例附件受累，13例继发椎管狭窄。结论 CT对椎体结核的诊断敏感性高，有利于指导临床治疗及制定手术方案。     

Intradural extramedullary tuberculoma of the thoracic spine: paradoxical response to antituberculous therapy

Intradural extramedullary tuberculoma of the spinal cord (IETSC) is a rare complication of tuberculosis, which can occur as a paradoxical response to antituberculous therapy. A 46-year-old woman with tuberculosis meningitis developed an acute sensory disturbance and paraplegia eight weeks after the antituberculous treatment was started. MRI revealed a cystic lesion at the Th 2 and 3 vertebrae levels, and continuous dural thickening. Laminectomy was performed; soft granulomas were unexpectedly observed inside the dura matter. After the operation, the patient experienced progressive improvement in motor strength. IETSC should be known as rare but possible complication of tuberculous meningitis.     

Magnetic resonance imaging of the craniovertebral junction in rheumatoid arthritis

Conventional radiography and magnetic resonance imaging (MRI) of the craniovertebral junction were evaluated in 12 patients with longstanding rheumatoid arthritis (RA) and neck pain with or without other neurologic signs or symptoms of cervical myelopathy. MRI demonstrated abnormal soft tissue masses thought to represent pannus in 9 patients. Three patients showed cord or brainstem compression due to pannus or atlantoaxial subluxation. The 3 patients with MRI evidence of cord or brainstem compression had neurologic signs or symptoms of cervical myelopathy, and appropriate therapy was instituted based on these findings. This study indicates that MRI is able to detect abnormal soft tissue masses which probably represent pannus and their relationship to the spinal cord or brainstem, and confirms the utility of the procedure in the management of craniovertebral involvement in RA.     

兔布鲁杆菌病性脊柱炎动物模型的建立

目的 探讨使用构建兔脊柱结核模型的相同方法用以构建新西兰兔布鲁杆菌病性脊柱炎动物模型,并对其可行性进行评价。方法 48只新西兰兔采用数表法随机分为实验组16只、对照组16只、空白组16只。实验组于第6腰椎(L6)上终板下方钻孔,填入明胶海绵,在其中浸注种植M5羊种布鲁杆菌弱毒苗混悬液0.1ml(3×10 ⁸CFU/ml);对照组浸注0.9% NaCl溶液0.1ml;空白组不做任何处理。 结果 术后8周兔存活率实验组为75.0% (12/16)、对照组为87.5% (14/16),空白组为100.0% (16/16)。实验组术后4周CT扫描三维重建结果显示5只出现椎间隙变窄,MRI检查结果显示7只有椎旁软组织脓肿形成;对照组未出现椎旁软组织脓肿形成,椎间隙无变化。实验组术后8周行CT扫描三维重建复查,结果显示8只出现椎间隙变窄,MRI检查结果显示10只出现椎旁软组织脓肿形成及椎间盘信号改变;对照组未见椎旁软组织脓肿形成及椎间盘信号改变。实验组术后8周进行组织病理学检查,显示兔椎旁软组织均有病变组织细胞增生及以淋巴细胞为主的炎性细胞浸润;对照组与空白组未出现病变组织细胞增生及炎性细胞浸润。结论 在新西兰兔腰椎椎体的上终板下钻孔、明胶海绵填塞、浸注种植M5羊种布鲁杆菌弱毒苗、石蜡封闭孔道的方法,可成功构建兔布鲁杆菌病性脊柱炎动物模型。     

Computed tomography and conventional radiographs of the craniocervical region in rheumatoid arthritis

Radiographs and computed tomography (CT) scans of 12 patients with rheumatoid arthritis of the cervical spine were reviewed to determine whether CT provides additional information to that obtained from conventional radiography and tomography. Modalities were compared with respect to determination of the extent of erosion, C1-C2 subluxation, atlantoaxial impact impaction, and soft tissue findings. CT showed greater extent of erosion in 9 of 12 patients. In 11 patients with C1-C2 subluxation, CT and plain radiographs were both useful because it was necessary to demonstrate both sagittal and axial relationships. In the 5 patients with atlantoaxial impaction both CT and plain radiographs demonstrated the abnormal relationships between the odontoid and the foramen magnum. CT showed attenuation of the transverse ligament and the presence or absence of spinal cord compression, whereas plain radiographs did not. Nevertheless, significant new information regarding the spinal cord was obtained by CT in only 1 of the 12 patients. Computed tomography provides additional information about the rheumatoid cervical spine that is unobtainable by conventional modalities. In particular, CT demonstrates bone changes in the axial projection and facilitates evaluation of soft tissue, ligament, and spinal cord involvement. However, CT should be reserved for those instances in which plain radiographs and tomograms do not explain clinical findings.     

Clinical and radiographic manifestations of tuberculous spondylitis in adults

Data on 348 adult patients with tuberculous spondylitis treated in 1994-1999 are analyzed. The radiation manifestations of spondylitis first occurring in maturity, which amount to 82.3% in the clinical setting were studied in 112 patients. In 50% of cases, spondylitis was a manifestation of multiorgan tuberculosis. The proportion of those with onset in youth increased (27.9). Isolated lesions of the corpus vertebrae were more frequently detected. The processes involving 2 vertebrae were predominant (61.2%), but complicated by foci at new levels. There was a drastic increase in the proportion of disseminated and multi-levelled spondylitis involving 3-9 vertebrae (36.9%). The exudative component of the inflammation was much pronounced, abscesses were extensive in all forms of spondylitis. Spinal cord deficit was noted in 68% of cases of thoracic and cervical spondylitis. MRI should be used for early diagnosis and determination of the extent of a process.     

Tuberculous spondylitis complicated by spinal disorders: diagnosis and treatment

Complex diagnosis using additional radiation procedures (computed tomography and magnetic resonance imaging) for tuberculous spondylitis complicated by spinal disorders was made in 52 patients. It made the genesis of spinal cord disorders more clear. The genesis was due to epidural abscess, necrotic osseous tissue and bony compression of destroyed vertebrae. Spinal cord structural changes were detectable in the postoperative period. Hemosorption in combination with blood ultraviolet radiation was used in 25 (40%) patients for their indications, which allowed all the patients to be operated on. Surgical treatment of 60 patients by using radical interventions into the target site and extended corporolateral decompression of the spinal cord, by employing autograft spondylolodesis resulted in rehabilitation in 95% of cases.     

Whiplash: a review of a commonly misunderstood injury

Whiplash injury is a relatively common occurrence, but its mechanism and optimal treatment remain poorly understood. It is estimated that the incidence of whiplash injury is approximately 4 per 1,000 persons. The most common radiographic findings include either preexisting degenerative changes or a slight flattening of the normal lordotic curvature of the cervical spine. Computed tomography and magnetic resonance imaging are generally reserved for cases of neurologic deficit, suspected disc or spinal cord damage, fracture, or ligamentous damage. Biomechanics studies have determined that after rear impact C6 is rotated back into extension before movement of the upper cervical vertebrae. Thus, the lower cervical vertebrae were in extension while the upper vertebrae were in a position of relative flexion, producing an S shape in the cervical spine. It is believed that this abnormal motion pattern might play a role in the development of whiplash injuries. Historically, a soft cervical collar has been used early after the injury in an attempt to restrict cervical range of motion and limit the chances of further injury. More recent studies report rest and restriction of motion to be detrimental and to slow the healing process.     

Evaluation of prognostic factors in medically treated patients of spinal tuberculosis

This study was aimed to determine the prognostic factors in medically treated patients of spinal tuberculosis. In this longitudinal observational study, from July 2010 to December 2011, 70 consecutive patients (40 males and 30 females) spinal tuberculosis were enrolled. Diagnosis of spinal tuberculosis was based on characteristic clinical and neuroimaging features. Diagnosis was histopathologically and/or bacteriologically verified. Patients received antituberculous treatment as per World Health Organization guidelines and were followed for 6 months. Disability was evaluated with modified Barthel index (MBI). Outcome was defined as good (MBI > 12) and poor (MBI ≤ 12). Various clinical and neuroimaging parameters, likely to affect the outcome, were analyzed using univariate and multivariate analysis. After 6 months, 45 patients had a good outcome, while 25 patients had a poor outcome. On univariate analysis, duration of illness >6 months (OR 0.062, CI 0.018–0.212), bladder involvement (OR 0.102, CI 0.033–0.317), spinal deformity (OR 0.050, CI 0.013–0.196), spastic paraparesis (OR 0.572, CI 0.190–1.723), and flexor spasms (OR 0.077, CI 0.021–0.280) were found as important clinical predictors of poor outcome. Involvement of more than 2 vertebrae (OR 0.095, CI 0.028–0.328), complete collapse (OR 0.072, CI 0.022–0.241), cord compression (OR 0.025, CI 0.003–0.204), spinal extension of the abscess (OR 0.044, CI 0.005–0.350), and thick/septate abscess wall (OR 0.062, CI 0.016–0.240) were the neuroimaging parameters associated with poor prognosis. However, on multivariate analysis, duration of illness >6 months (Exp-b 0.086, CI 0.019–0.378), cord compression (Exp-b 0.035, CI 0.003–0348), and spinal extension of the abscess (Exp-b 0.109, CI 0.017–0.91) were significant. Medical management results in clinical improvement in a majority of the patients of spinal tuberculosis. Duration of illness >6 months, cord compression, and spinal extension of abscess are associated with poor outcome.