脊柱结核与脊柱转移瘤的MRI表现差异探讨

目的 探讨脊柱结核与脊柱转移瘤的MRI形态及信号差异。方法 回顾性分析35例脊柱结核与68例脊柱转移瘤的MRI表现。结果 脊柱结核多发生于椎体前半部，以相邻多发和弥散形式出现，转移瘤多以单发形式出现，多发生于椎体中后部及附件，多发时多呈跳跃式分布。结核常累及椎间盘，而转移瘤较少累及椎间盘。结核椎体外肿块呈长条梭形，多呈周边强化或无强化。转移瘤的椎体外肿块呈半圆形，多为均匀强化，周边强化少见。结核多呈不规则长T2高信号，骨皮质破坏一般较小，低信号骨皮质向外移位较少，而转移瘤的骨皮质则多呈较多点状虫蚀状破坏，骨皮质多有向外移位征象，信号相对较均匀。结论 根据病变的信号特点及椎体骨皮质破坏情况及椎旁组织形态及信号差异，椎间盘破坏情况可较明确做出两者的鉴别诊断。

Differences of MRI appearance in spinal tuberculosis and metastases

Objective: To investigate the morphological and signal differences of spinal tuberculosis and metastases by means of MRI Methods: The MRI appearance of 35 patients with spinal tuberculosis and 68 patients with spinal metastases was retrospectively analyzed Results: The reliable MRI findings for vertebral tuberculosis were as follows: involvement of anterior portion of vertebral body, multiple or diffuse bone destruction, the involvement of intervertebral disc, long feature with paravertebral mass, only edge enhancement or no enhancement of paravertebral mass, irregular high T 2WI signal, little destruction lesion and replacement in compact bone Vertebral metastases were characterized by the involvement of posteriomedial portion of vertebtal bone, single bone destruction, skipping distribution in multiple destruction, normal disc, half round with paravertebral mass, unobvious edge enhancement of paravertenral mass, spot destruction and replacement in compact bone and regular signal Conclusion: The differences in the signal features, destruction of vertebral body, the conformation and signal of paravertebral mass are helpful in differentiating diagnosis