MR椎体终板破坏分型鉴别诊断布鲁菌性脊柱炎与结核性脊柱炎

目的 通过不同的椎体终板破坏分型分析布鲁菌性脊柱炎（BS）与结核性脊柱炎（TS）的骨质破坏的形态学差异。方法 对37例BS和35例TS患者术前均行脊柱MR检查。将椎体终板骨质破坏按形态学特征分为5型（边缘型、中央1型、中央2型、混合型、完全型），对BS及TS的MRI图像进行分型，并将观察结果进行统计学分析。结果 BS中央1型椎体终板骨质破坏的发生率明显高于TS（P<0.001）；TS混合型椎体终板骨质破坏的发生率明显高于BS（P<0.001）；BS和TS边缘型、中央2型、完全型发生率的差异无统计学意义（P均>0.05）。BS和TS病变部位及MR其他观察结果（包括椎体T1WI低信号、T2WI脂肪抑制高信号、椎间隙狭窄、椎间盘信号异常）差异均无统计学意义（P均>0.05）。结论 BS和TS在病变椎体终板骨质破坏的形态学上存在差异，有助于两者在MRI影像上的鉴别诊断。

MR classification of vertebral endplate destruction in differential diagnosis of Brucellar and tuberculous spondylitis

Objective To explore the morphological discrepancy of bone destruction of Brucellar spondylitis (BS) and tuberculous spondylitis (TS) by the classification of vertebral endplate destruction. Methods A total of 37 patients with BS and 35 patients with TS were performed spine MR examination before surgery. Bone destruction of vertebral endplate were classified into 5 types (peripheral, central 1, central 2, mixed, complete) by morphological feature. The MR images of BS and TS were classified and the statistical analysis was performed. Results The incidence of MRI findings as bone destruction of vertebral endplate in central 1 type of BS was significantly higher than that of TS (P<0.001); the incidence of MRI findings in mixed type of TS was significantly higher than that of BS (P<0.001). There were no statistical differences of incidence of MRI findings as bone destruction of vertebral endplate in peripheral, central 2, and complete types between BS and TS. There were no statistical differences of lesion locations and other MRI findings (including decreased signal intensity in T1WI, increased signal intensity in fat suppression T2WI, narrowing of disc spaces, abnormal intensity of intervertebral disk) between BS and TS (all P>0.05). Conclusion The morphological discrepancy of bone destruction in vertebral endplate is helpful in MRI differential diagnosis of BS and TS.