脊椎嗜酸性肉芽肿的影像诊断及误诊分析

目的分析脊椎嗜酸性肉芽肿的X线表现,分析其误诊原因,以提高对该疾病的诊断正确率。方法回顾性分析10例经手术、病理证实的脊椎嗜酸性肉芽肿的临床资料及X线、CT及MRI等影像资料,其中X线10例、CT 5例及MRI 4例。结果发生于颈椎3例、胸椎5例、腰椎2例,其中8例单发,2例累及2个相邻两个锥体。X线表现为4例椎体明显塌陷变扁,前后径及横径均有不同程度的增宽,呈硬币征。4例呈不同程度楔样变。2例呈局部类圆形骨质缺损,边界清楚。3例附件破坏伴软组织肿块。7例椎间隙大致正常,2例椎间隙稍增宽,1例椎间隙稍变窄。6例有不同程度椎旁软组织肿胀或肿块影。结论脊椎嗜酸性肉芽肿的X线表现有一定的特征性,但正确诊断有赖于临床、影像学表现相结合,细致综合的分析能提高对该病的诊断水平。

The analysis of imaging diagnosis and misdiagnosis of vertebral eosinophilic granuloma

Objective To analyze the imaging features of vertebral eosinophilic granuloma and the reasons of misdiagnosis,so as to improve the diagnosis accuracy of the disease.Methods The clinical materials and images findings of 10 patients with vertebral eosinophilic granuloma proved by surgery and histopathology were analyzed retrospectively.Results Of all the cases,3 of them were located in cervical vertebra,5 in thoracic vertebra and 2 in lumbar vertebra.8 lesions were single and 2 involved the adjacent 2 vertebrae.4 lesions showed obvious sinking and flattening of the vertebra body,with widening anteroposterior and transverse diameters,4 cases showed wedge-shaped appearance,2 cases showed well-defined oval deossification.The appendix of vertebrae in 3 lesions were destroyed with surrounding mass.The intervertebral spaces were normal in 7 cases,slightly widened in 2 cases and slightly narrowed in 1 case.6 cases showed paravertebra soft tissue swelling or soft tissue mass formation.Conclusion Though there are some imaging features of vertebral eosinophilic granuloma,close combination with clinical dates and careful analysis of imaging findings can effectively improved the diagnosis accuracy.