脊柱结核的MRI表现

目的：探讨MRI对脊柱结核的诊断价值。方法：回顾分析98例经手术病理证实的脊柱结核患者的脊柱MRI征象，观察椎体、终板、椎间盘及椎管等变化，并与X线平片及CT片进行比较。结果：椎体结核早期．MRI上可见椎体形态正常，椎体前中部骨质破坏，呈片状长T1、长T2信号影，边界不清；椎体终板局限性破坏．椎间盘信号不均匀，可见囊状小脓肿形成；椎旁软组织肿胀或少量脓肿形成。MRI对椎体破坏、椎间盘受累、椎旁脓肿及椎管受累的诊断优于X线平片及CT（P〈0．05）。结论：MRI对病变椎体病理改变具有高敏感性，使脊柱结核的早期诊断成为可能。MRI可清晰最示脊柱结核的椎体骨炎、椎旁脓肿、终板破坏及受累椎管狭窄程度．并有助于与椎体肿瘤的鉴别。     

老年脊柱结核的外科治疗

目的：根据老年脊柱结核的特点,探讨手术方式的选择。方法：回顾分析我科自1998年9月-2004年2月收治的66例60岁以上脊柱结核病人,均采用前路一期病灶清除、植骨融合内固定术治疗。结果：3例胸膜撕裂术中修复,术后无不良反应。2例术后出现肺部感染,呼吸衰竭,2例术后出现刀口延迟愈合,无截瘫组2例术后出现神经损伤2周内恢复,截瘫组除2例瘫痪时间较长无恢复,余均有明显恢复,其中8例术后1周内感觉、运动均恢复正常。所有病人随访4月。6年,平均3．2年。所有植骨均在4-9个月愈合,无假关节形成。结论：彻底的清除病灶,适当的复位,牢固的固定和良好的融合是老年脊柱结核手术治疗的基本原则,大胆采取内固定,老年脊柱结核在腰背支架保护,早期康复功能锻炼。     

脊柱结核的MRI分型系统

目的 建立脊柱结核MRI的南方医科大学(Southern Medical University,SMU)分型系统,探讨其在脊柱结核诊断、手术适应证明确及术式选择方面的应用.方法 回顾性分析230例脊柱结核患者MRI资料,从椎间盘退变、椎体信号异常、脓肿形成、椎体塌陷、后凸畸形、矢状面指数、稳定性、脊髓或神经根受压及椎管占位等影像学特征进行分型.根据此分型,制定手术预案.结果 230例脊柱结核分为五个类型:信号改变型(Ⅰ型)、脓肿形成型(Ⅱ型)、椎体破坏型(Ⅲ型)、椎管占位型(Ⅳ型)和后凸畸形型(Ⅴ型).230例患者中,Ⅰ型28例,Ⅱa型13例,Ⅱb型26例,Ⅲ型78例,Ⅳ型46例,Ⅴ型39例(Ⅴa型13例,Ⅴb型26例).Ⅰ型25例患者获随访:20例采取非手术治疗,复发2例;5例行前路病灶清除术,无复发.Ⅱa型12例患者获得随访:6例行非手术治疗;6例行前路病灶清除术,复发1例.Ⅰ型和Ⅱa型患者手术治疗与非手术治疗复发率差异无统计学意义(P＞0.05).其余各型脊柱结核,均按照预案进行手术治疗,各治疗组间复发率差异无统计学意义(P＞0.05).结论 脊柱结核MRI的SMU分型有利于进一步明确手术适应证,便于选择不同术式,在脊柱结核外科治疗干预方面有积极指导意义.

Abstract：

Objective To outline the classification of spinal tuberculosis based on MRI findings (Southern Medical University classification,SMU classification) and explore its use in the diagnosis,surgical protocols.Methods The MRI data from 230 cases with spinal tuberculosis were analyzed retrospectively.Our classification system was based on clinical and radiological criteria (abscess formation,disc degeneration,vertebral collapse,kyphosis,sagittal index,instability and neurological problems).The surgical strategies were made according with this classification.Results Two hundred and thirty cases with spinal tuberculosis were classified into the 5 types.There were signal change type (type Ⅰ) in 28 cases,abscess formation type (type Ⅱ) in 39,vertebral collapse type (type Ⅲ) in 78,canal compression type (type Ⅳ) in 46 and kyphosis type (type Ⅴ) in 39 respectively.In type I lesion,25 patients had been followed up.Twenty patients were treated medically.Recurrence of tuberculosis was found in 2 cases.Surgical meticulous debridements were done in 5 cases without recurrence.In type Ⅱa lesion,6 patients were treated medically.The other 6 patients underwent surgical meticulous debridement with recurrence occurred in one patient.There was no difference between medical and surgical treatment regarding outcomes in patients with type Ⅰ and Ⅱa lesion.In type Ⅱb-Ⅴ,surgical treatments were carried out according to the pathological changes.There was no difference between medical and surgical treatment regarding outcomes in the patients with type Ⅱb-Ⅴ.Conclusion The SMU classification helps in differentiating the various manifestations of spinal tuberculosis and appears to correlate with the surgical treatment of spinal tuberculosis.We believe that this new classification system can be used as a practical guide in the treatment of spinal tuberculosis.     

儿童脊柱结核的MRI随访观察

目的：探讨MRI在儿童脊柱结核随访中的应用价值.方法：对2004年2月至2013年4月的21例经临床或手术诊断为脊柱结核的儿童患者MRI表现进行回顾性分析,其中男11例,女10例;年龄2～14岁,平均9.4岁.18例保守治疗,3倒手术治疗,病程2个月～3年,所有病例行2次或2次以上MRI检查.比较初次和复查结果,主要观察椎体及椎间隙信号变化、椎旁脓肿及后凸角的变化.结果：21例脊柱结核患者共累及85个椎体,其中颈椎、胸椎及腰骶椎发生率分别为10.6％（9/85）,49.4％ （42/85）及40％（34/85）.初诊及随访时相仿,15例出现椎体变扁或楔形变,10例可见椎间盘受累,而椎间隙可见不同程度变窄或融合.初诊13例后凸角＞0°,位于胸段7例,胸腰段2例,腰段3例,颈段1例.18例保守治疗患儿中,8例初诊及治疗过程中（2～9个月）后凸角均为0°;1例轻度后凸患儿（＜10°）,治疗12个月时后凸角稍增加;5例中度后凸患儿（10°～30°）,治疗过程中（3～12个月）多次随访均无明显改变;4例重度后凸患儿（＞30°）,保守治疗过程中及治疗后（3～28个月）多次随访后凸畸形均有不同程度加重,其中1例保守治疗失败后行手术治疗后凸角减小.结论：儿童脊柱结核运用MRI随访具有重要意义,能够清晰显示治疗后椎体及椎间隙信号变化、椎旁脓肿及后凸角的变化,为临床治疗及评估预后提供参考.     

CR、CT、MRI在脊柱结核诊断中的临床价值

[目的]评价计算机X线摄影(CR)、计算机断层成像(CT)、磁共振成像(MRI)在脊柱结核诊断中的临床价值。[方法]回顾分析经病理证实的41例脊柱结核的影像学资料。41例做了CR,22例做了CT,31例均做了MRI。[结果]41例中38例CR片清晰显示骨质改变及椎间隙狭窄或消失,30例CR片可看到软组织阴影。22例CT均清晰显示了钙化,22例CT检查附件均未见明显异常,21例CT清晰显示椎体骨质改变,20例CT显示了软组织阴影。31例MRI均显示软组织均受累,附件均未见受累,其中29例椎间隙狭窄或消失。病变T1WI均以低信号为主,T2WI均以高信号为主。[结论]CR片仍为脊柱结核的基本检查方法,CT较好显示了结核的破坏范围及细微钙化,MRI对显示结核的侵犯范围、软组织异常及椎间盘异常有明显优势。三者相结合有助于脊柱结核的诊断。     

MRI在脊柱肿瘤结核鉴别诊断中的价值

[目的]评价磁共振成像（MRI）在脊柱肿瘤、结核鉴别诊断中的价值。[方法]回顾分析经病理证实的63例脊柱病变（31例结核，32例肿瘤）MRI资料。[结果]32例肿瘤椎间盘均未受累，其中10例仅累及椎体，20例椎体、附件均受累，2例仅累及附件。31例结核软组织均受累，附件均未见受累，其中29例椎间隙狭窄或消失。无论结核，还是肿瘤，T1WI以低信号为主，T2WI以高信号为主。[结论]MRI有助于脊柱肿瘤、结核鉴别诊断，椎间盘未受累为肿瘤特点，椎间盘、软组织受累及附件完整为脊柱结核的特点。     

脊柱结核影像学诊断现状

脊柱结核起病隐匿,发展较慢,特异性临床表现不十分突出.因此,影像学诊断是该病的主要诊断方法.目前常用的各种方法及其引导的介入诊断各有特点,互为补充,且均在临床诊断中发挥重要作用,分述如下.     

老年脊柱结核外科治疗体会

老年脊柱结核外科治疗体会赵振久，陈晓亮，邹云雯，葛文学，田炳基，丁同联，肖兴国老年脊柱结核外科治疗的文献报道较少。由于患者合并症多，病情复杂，使临床手术治疗困难。我院从１９７８年至今共收治６０岁以上脊柱结核１７例。现将我们的治疗体会报告如１临床资料性...     

老年脊柱结核患者的临床特点和术式选择

 目的 总结老年脊柱结核患者的临床特点,探讨老年脊柱结核患者手术方式的选择策略。方法 2005年10月至2010年10月采用6种手术方式治疗老年脊柱结核患者151例,69例患者纳入研究,男36例,女33例;年龄60~83岁,平均68.3岁。62例（171例次）合并有其他疾病。记录患者的临床表现、发病部位及影像学表现。统计误诊、误治的发生情况。在治疗前、术后1周及末次随访时采用疼痛视觉模拟评分(visual analog scale, VAS)进行对比分析,对伴有脊髓神经损害患者采用Frankel分级评价术后脊髓神经功能改善情况。结核临床治愈判定采用脊柱结核治愈标准。结果 所有患者均有不同程度的局部疼痛,VAS评分平均为（8.2±1.4）分,严重疼痛者（VAS评分7分以上）42例（60.9%）。72.5%的患者无明显结核中毒症状,68.1%的患者有脊髓神经损害表现,43.5%的患者无椎旁脓肿或腰大肌脓肿。腰椎结核发病率最高（78.3%,54/69）,双椎体结核最常见（59.4%,41/69）。均有轻、中度的后凸畸形,Cobb角平均为20.4°±4.3°。误诊率为30.4%（21/69）,误治率为13.0%（9/69）。获得平均27个月随访,结核临床治愈67例,2例窦道形成,迁延未愈。融合节段（4.1±0.6）个,骨融合时间（5.9±1.7）个月。术后后凸畸形矫正9.5°±3.6°,末次随访时矫正角度丢失7.2°±2.3°。5例伴有脊髓神经损害者术后Frankel分级至少提高了1级。术后肺部感染5例（其中死亡1例）,心功能不全5例,脑梗死2例,内固定松动2例,窦道形成5例,药物性肝损害5例,药物性皮疹6例,术后神经功能损害加重1例。结论 老年脊柱结核患者起病隐匿,多合并其他疾病,易导致误诊、误治。手术方式的选择应遵循个体化及微创的原则,术中固定节段应适当延长。     

磁共振IVIM-DWI评估脊柱结核的价值观察

目的 探究磁共振IVIM-DWI技术在诊断脊柱结核中的价值。方法 采集2018年1月～2020年1月在我院确诊的脊柱结核患者36例作为实验组,随机选取同时期检查明确为正常的36名志愿者为对照组。采用西门子Signa 3.0T扫描仪,进行脊柱磁共振常规扫描以及脊柱磁共振IVIM-DWI扫描,采用双指数模型进行后期处理,得到磁共振体素内不相干运动扩散加权成像(intravoxel incoherent motion diffusion weightedimaging, IVIM-DWI)定量数据,即：单纯扩散系数(D)值、伪扩散系数(D^*)值、灌注分数(f)值,并进行比较。结果 (1)实验组病变椎体D值、D^*值显著高于对照组,f值显著低于对照组,差异有统计学意义(P<0.05);(2)实验组病变椎间盘的f值、D值显著高于对照组(P<0.05),两组的椎间盘D^*值差异无统计学意义(P>0.05,见表3);(3)ROC曲线分析得出,36例患者病变椎体D值的诊断阈值为0.62×10^-3 mm...     

Bacteriologically confirmed pulmonary tuberculosis in childhood. Clinical and radiological features

Over a 4-year period 185 cases of pulmonary tuberculosis in children were confirmed by culture of Mycobacterium tuberculosis, usually from gastric aspirate. The majority of cases occurred in boys (62%) and the younger age groups were more commonly affected--26% of patients were less than 1 year old and 65% less than 3 years of age. At the time of presentation 40% of the 151 children tested had a negative tuberculin test. A chest radiograph was available in 136 cases. The commonest changes seen were lymphadenopathy (63%) and segmental lesions (56%). The latter affected mainly the right lung and in particular the right middle lobe. Cavitating tuberculous disease was present in 19 children, including 5 aged less than 1 year.     

Evaluation of radiological investigations in spinal tuberculosis

Summary Thirty-four cases of spinal tuberculosis were investigated by plain radiography, computerised tomography and myelography followed by computerised tomography. All the patients were operated on and the findings compared with the results of the investigations.

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Résumé Étude de 34 cas de tuberculose vertébrale. Tous les malades ont été examinés par radiographie standard et par tomo-densitométrie. Des tomographies ont été pratiquées dans 11 cas et des myélographies suivies de tomo-densitométrie également dans 11 cas. Tous les malades ont été traités chirurgicalement et les constatations opératoires ont été comparées aux résultats des investigations radiologiques.

     

儿童胸椎结核的临床及影像学特点

目的：探讨儿童胸椎结核的临床及影像学特点，为其临床诊断和治疗提供参考。方法：1997年6月～2007年6月我院收治69例儿童胸椎结核患者，其中男36例，女33冽，年龄1～14岁，平均5．9岁，对其临床及影像学特点进行归纳分析。根据脊髓神经功能受损与否分为截瘫组与脊髓神经功能正常组，比较其受累椎体数目。根据后凸Cobb角角度和患病节段分组，比较其截瘫率：结果：病程平均15．1个月，受累椎体平均3．2个，后凸Cobb角平均37．5&#176;，合并截瘫26例（37．7％）。首诊原因以脊柱后凸畸形（34．8％）多见：常见症状以下肢症状（50．7％）多见，包括下肢无力、步态不稳等；常见体征以后凸畸形（92．8％）多见。截瘫组受累椎体数为3．6&#177;1．5（2～8）个，多于脊髓神经功能正常组的2．9&#177;1．0（2-6）个，有昆菩性差异（P〈0．05）；上胸椎结核截瘫率为84．6％（11／13），高于中下胸椎结核的26．8％（15／56），有显著性差异（P〈0．05）：后凸Cobb角≥30&#176;者截瘫率为45．8％（22／48），高于后凸Cobb角〈30&#176;者的截瘫率19．0％（4／21），有显著性差异（P〈0．05）；病程、受累椎体数、后凸角度问有相关性（相关系数r为0．338—0．535，P〈0．05）。35例胸椎MRI示2个或2个以上相邻椎体T1低信号，1．2高或混杂信号；椎旁软组织影边缘清楚，T1低信号，1．2高或混杂信号；受累椎间盘消失或1．2低信号。MRI对椎间盘受累及椎管受累的显示优于X线平片及CT（P〈0．05）。结论：儿童胸椎结核早期易延误诊断．易导致严重后凸畸形。截瘫的危险因素包括上胸椎、多椎体受累和后凸Cobb角≥30&#176;．MRI检查有助于早期诊断。     

后路一期病灶清除加重建治疗老年脊柱结核

目的：评价后路一期病灶清除加重建手术治疗老年脊柱结核的疗效。方法回顾性分析2005年10月～2011年10月行后路一期病灶清除加重建手术治疗的107例老年脊柱结核患者（≥70岁）的临床资料,从手术时间、出血量、术后3个月内并发症、植骨融合情况、瘫痪恢复情况、疼痛视觉模拟量表（ visual analog scale, VAS）评分和结核是否复发等方面来评估手术疗效。结果手术平均时间135 min,术中平均出血量315 mL。随访12～42个月,术后3个月内并发症的发生率为14．9％,与手术直接相关的并发症发生率为4．7％。所有病例椎间植骨均获得骨性融合,融合时间平均6．3个月。 Cobb角手术平均矫正7．1°,随访期内平均角度丢失1．9°。术后瘫痪改善率87．8％。疼痛VAS评分术前平均6．3分,术后1个月平均3．5分,末次随访时平均2．1分,均较术前明显改善。所有患者脊柱结核均临床治愈,末次随访时未发现结核复发。结论后路一期病灶清除加重建手术疗效可靠,适用老年脊柱结核的治疗。     

非典型性脊柱结核影像学分型与表现形式

 目的 探讨成人非典型性脊柱结核的影像学分型与表现形式。方法 回顾性分析并总结2000年2月至2012年10月经病理确诊的45 例成人非典型性脊柱结核患者资料,男29例,女16例;年龄20~71岁,平均46.2岁;25例有潮热、乏力及消瘦表现,20例无明显全身结核中毒表现;37例红细胞沉降率为25~107 mm/1 h,8例正常。所有患者均摄脊柱X 线片,并行CT扫描及MR检查, 其中12例辅加脊柱螺旋CT三维重建,2例辅加PET-CT检查。45例患者均行外科手术治疗,其中3例术前行CT引导下病灶穿刺活检;均经病理检查证实为脊柱结核。结果 非典型性脊柱结核的影像学分型包括,单椎体型（9例）,MRI T2WI示单一椎体病灶呈不均匀高信号,CT扫描示老年人病变椎体以虫蚀样、溶骨性破坏为主,青年人病变椎体内呈单个均匀透光的圆形溶骨性骨质破坏区;单脊椎椎体附件型（2例）,MRI T2WI示椎体附件呈高信号改变,CT扫描示椎板及椎弓根呈虫蚀样骨质破坏;单脊椎全椎骨型（8例）,CT扫描示单脊椎的椎体及附件均呈虫蚀样广泛骨质破坏;椎间盘型结核（5例）,MRI示椎间盘信号减低,团状的椎盘组织突入椎管压迫脊髓;多发性相邻型脊柱结核（14例）,螺旋CT示多个相邻椎体虫蚀样骨质破坏;多发性非相邻型（跳跃型）脊柱结核（7例）,MRI示非相邻多个椎体在T2WI上呈现椎体骨质结构破坏的混杂信号,其中个别病例T2WI示高信号的椎旁脓肿通过流注方式波及多个非相邻椎体。结论 非典型性脊柱结核有多种影像学表现形式且极不典型,但虫蚀样骨质破坏、骨髓水肿、前和（或）后纵韧带高信号等影像学改变均为非典型性脊柱结核影像学的特征性表现。
     

非典型性脊柱结核的影像学特征

目的：探讨成人非典型性脊柱结核的影像学特征。方法：1998年1月至2006年5月收治的成人脊柱结核的患者中资料者完整200例，其中19例为非典型性脊柱结核，椎间盘型2例，椎体型4例，椎弓型4例，全椎骨型2例，跳跃型4例，多发性骨结核型3例。回顾分析其影像学特征。结果：非典型性脊柱结核主要的影像学特征为：①椎体骨赘形成，主要见于椎间盘型及椎体型；②椎体前柱破坏，见于椎体型；③椎体终板虫蚀样破坏，见于椎间盘型和椎体型；④椎旁软组织影中脓液成分，见于各型；⑤连续单侧骨破坏，见于椎弓型；⑥影像学破坏重，面全身症状轻，即影像学表现与症状不对称，见于多发性骨结核型和跳跃型，根据上述影像学特征可以与脊柱转移癌相鉴别。结论：了解非典型性脊柱结核的影像学特征有助于临床诊断和鉴别诊断，减少或避免误诊误治。     

The radiological features of primary pulmonary tuberculosis.

A very brief review is given of the pathology of primary pulmonary tuberculosis. Numerous characteristic, but not pathognomonic, radiological appearances of primary pulmonary tuberculosis are briefly described and some of them are illustrated. The final diagnosis, however, depends on correlating the radiological picture with the clinical picture and special investigations.     

Clinical and radiological features of adrenal cysts

Adrenal cysts are very rare lesions, usually asymptomatic or without characteristic symptoms. They are classified as pseudocysts, endothelial cysts, epithelial cysts or parasitic cysts. Although pseudocysts are reported to be the most common clinically recognized adrenal cysts in surgical series, endothelial cysts are more common in autopsy series. We studied 15 consecutive patients with adrenal cysts who underwent surgical resection at our institution from 1990 to 2005. Of 15 patients with adrenal cysts, 10 had pseudocysts, 3 epithelial cysts, 1 an endothelial cyst and 1 a parasitic cyst. In conclusion, a better understanding of cystic adrenal masses is necessary to recognize true adrenal cysts and differentiating them from adrenal carcinoma or adenoma by demonstrating the foci of cystic or degenerative changes.     

Suprasellar arachnoid cysts in adults: clinical presentations,radiological features,and treatment outcomes

A tendency for suprasellar arachnoid cysts (SACs) to occur in young children is known. Data of adult SACs were rare in previous reports. The aim of this study is to discuss their clinical presentations, radiological features, and treatment outcomes based on 23 adult patients who underwent endoscopic fenestration in our hospital between January 2003 and December 2018. Preoperative cyst volume ranged from 12.3 to 72.5 cm³ (mean 39.8?±?19.8). Endocrine disorders occurred in 7 (30.4%) patients. Hydrocephalus was observed in 20 patients. In the patients with hydrocephalus, the mean preoperative Evans’ index (EI) (%) and frontooccipital horn ratio (FOHR) (%) were 44.8 (ranged 32.2–63.4) and 49.6 (ranged 36.7–59.8), respectively. A bivariate correlation showed significant positive association between preoperative cyst volume and preoperative EI or FOHR (Pearson correlation, r?=?0.607, p?=?0.005; r?=?0.583, p?=?0.007). The slit-valve phenomenon was observed in 13 (56.5%) patients. Pale/tenacious cyst walls were observed in 12 (52.2%) patients. Postoperatively, all patients achieved the improvement in clinical symptoms and a decrease in cyst size. The mean decreases in cyst volume, EI, and FOHR were 64.7%, 7.89%, and 5.8%, respectively. A bivariate correlation indicated the irrelevance between the postoperative cyst volume and postoperative EI or FOHR (Pearson correlation: r?=?0.37, p?=?0.11; r?=?0.43, p?=?0.054). These results reveal that there are a few differences in several aspects between adult patients and child patients. The severity of hydrocephalus is correlated with cyst size in adult patients. Additionally, the excellent outcomes in adult SACs can be obtained by endoscopic fenestration.