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。

The radiographic classification and presentations of atypical spinal tuberculosis

Objective To investigate the radiographic classification and presentation of atypical spinal tuberculosis in adults. Methods Data of 45 consecutive patients who had suffered from atypical spinal tuberculosis confirmed by surgical interventions and pathologic examinations at our department from February 2000 to August 2012 were retrospectively analyzed. There were 29 males and 16 females, aged from 20 to 71 years (mean, 46.2 years). Twenty-five patients presented with low-grade fever, lassitude and loss of weight, and the other 20 patients denied the constitutional symptoms of tuberculosis. An increased erythrocyte sedimentation rate (range, 25-107 mm/1 h) was found in 37 patients. All patients were investigated by the following imaging resources: plain X-rays, CT scan and MRI. 3D reconstruction CT was performed in 12 patients and PET-CT was performed in 2 patients. All patients were treated surgically and confirmed by pathologic examinations and 3 patients had undergone CT-guided biopsy. Results Atypical spinal tuberculosis presented in different radiographic presentation forms. Nine patients had involvement of a single vertebral body, which was depicted with nonuniformly increased signal intensity on T2-weighted MR images. CT scan showed irregular bony destruction in old patients and solitary osteolytic lesion with well-defined margins in young adults. There were 2 cases of isolated affection in the posterior elements (vertebral appendages type), and the involved vertebral appendages demonstrated hyperintense signal on T2-weighted MR images and bony destruction on CT scan. There were 8 cases of simultaneous affection in the anterior and posterior element of one vertebra (circumferential vertebral involvement type), and CT scan showed multiple bony destruction in vertebral body and neural arch. There were 5 cases of affection in disc (intervertebral disc involvement type), which presented decreased signal in MRI and protruding disc pressing the dural sac could be found. There were 14 cases of multiple vertebral tuberculosis in continuity (contiguous spinal tuberculosis), which presented multiple tuberculosis lesions on 3D-CT. There were 7 cases of multiple vertebral tuberculosis in noncontinuity (noncontiguous spinal tuberculosis), which presented destructive tubercular lesions affected different levels in different regions of the spine on MRI. Conclusion Atypical spinal tuberculosis had multiply radiographic presentation forms and atypical radiographic features. Worm-eaten destruction of bone or vertebral endplate, marrow edema and increased signal intensity of paraspinal ligament are features of radiographic presentation in diagnosis of atypical spinal tuberculosis.