脊柱结核的比较影像学研究

目的：探讨脊柱结核的MRI、ECT、SCT、BUS、X线征象及其诊断价值。方法：回顾性分析16例经手术病理临床或随访证实的脊柱结核的MRI、ECT、SCT、BUS、X线平片表现。结果：16例脊柱结核MRI发现37个椎骨异常、11处椎管受累、19处冷脓肿、16处椎间盘受累；CT发现7处附件受累、26处死骨形成。ECT检出的41处病灶表现为多处放射性浓聚或单发放射性浓聚，其中6处为假阳性；BUS检出9处冷脓肿、7处椎体破坏、2处附件异常。X线平片显示27个椎骨受累。本组MRI、ECT、SCT、BUS、X线平片诊断脊柱结核的敏感性分别为：100％，94．6％，83．8％，24．3％，73．0％；特异性分别为100％，83．8％，97．3％，97．3％，94．6％。结论：RMI是一种诊断脊柱结核高敏感性和特异性的方法，脊柱结核临床首选X线检查，B超可作为补充手段；CT检查是必须的；ECT仅在与脊柱转移瘤或多发性骨髓瘤鉴别困难时应用。

Imaging comparison study of MRI,ECT,SCT,BUS and X-ray in spinal tuberculosis

Objective:To explore and compare the findings, sensitivity, specificity and diagnostic value of MRI,ECT, SCT,BUS and X-ray in the diagnosis of spinal tuberculosis.Methods:The MRI appearances of 16 cases with spinal tuberculosis proved by clinical or pathology were analyzed and compared with the finding on ECT, CT, BUS and plain X-ray.Results:There were 37 lesions with destruction of vertebral bodies on MRI, 11 lesions with involvements of vertebral canals on MRI, 19 lesions with cold abscesses on MRI, 16 lesions with intervertebral discs were destroyed on MRI, 7 lesions with accessory parts were destroyed on CT, 26 lesions with bone-sequester on CT. ECT manifested multiple or single abnormal foci of increased radio-nuclide activity in 41 lesions with 6 lesions with false positive.9 lesions with cold abscesses, 7 lesions with destruction of vertebral bodies and 2 lesions with accessory parts were showed through BUS. The sensitivity of MRI,ECT,SCT,BUS and X-ray is 100%,94.6%,83.8%,24.3%,73.0%;The specificity of MRI,ECT,SCT,BUS and X-ray is 100%,83.8%,97.3%,97.3%,94.6%.Conclusion:The MRI finding of spinal tuberculosis is of high sensitivity and specificity, which can manifest early spinal tuberculosis. X-ray plain is the first method in clinic to diagnose spinal tuberculosis,if necessary,combined with BUS.In general,CT scan is necessary. ECT is helpful in differential diagnosis among tuberculosis,metastasis and multiple myeloma of spine.