脊柱结核与脊柱转移瘤的磁共振弥散加权成像影像学特征分析

目的:探讨磁共振弥散加权成像（MRI-DWI）技术诊断脊柱结核与脊柱转移瘤的临床价值。方法:选取经病理学检查确诊的脊柱结核患者48例、脊柱转移性肿瘤62例，收集时间为2015年1月到2016年8月。所有患者均行MRI-DWI检查，对两组患者的影像学资料进行分析，探讨MRI-DWI鉴别诊断脊柱结核与脊柱转移性肿瘤的临床价值。结果:在b=500 s/mm2时，脊柱结核组患者的正常椎体表观弥散系数（ADC）值与脊柱转移瘤患者的正常椎体ADC值比较，差异无统计学意义（P>0.05）；脊柱结核患者椎体病灶、骨髓水肿、椎旁病变组织的ADC值显著高于脊柱转移瘤患者，差异均具有统计学意义（P<0.05）。脊柱结核组患者的信噪比与脊柱转移瘤患者比较，差异无统计学意义（P>0.05）。脊柱结核患者衰减百分比显著高于脊柱转移瘤患者，差异具有统计学意义（P<0.05）。MRI-DWI鉴别诊断脊柱结核与脊柱转移瘤的灵敏度为93.55%、特异度为93.75%、漏诊率为6.45%、误诊率为6.25%，诊断一致性kappa值为0.871。结论:MRI-DWI技术鉴别诊断脊柱结核与脊柱转移瘤具有较高的灵敏度和特异度，与病理学结果的一致性较高。

Imaging features of magnetic resonance imaging-diffusion weighted imaging on spinal tuberculosis and spinal metastatic tumor

: Objective To evaluate the clinical value of magnetic resonance imaging-diffusion weighted imaging (MRI-DWI) in the differential diagnosis of spinal tuberculosis and spinal metastatic tumor. Methods From January 2015 to August 2016, 48 patients with pathologically confirmed spinal tuberculosis and 62 patients with pathologically confirmed spinal metastatic tumor were selected. All patients underwent MRI-DWI examination. The imaging data of patients in the two groups were assessed for discussing the clinical value of MRI-DWI in the differential diagnosis of spinal tuberculosis and spinal metastatic tumor. Results At b=500 s/mm2, no statistical significance was found in the apparent diffusion coefficient (ADC) value of normal vertebral body between spinal tuberculosis group and spinal metastatic tumor group (P>0.05), while the ADC values of vertebral focus, bone marrow edema and paravertebral lesion were obviously higher in tuberculosis group as compared with spinal metastatic tumor group, with statistical differences (P<0.05). Tuberculosis group and spinal metastatic tumor group didn’t showed any statistical differences in signal-to-noise ratio (P>0.05). The SAR of tuberculosis group was remarkably higher than that of spinal metastatic tumor group (P<0.05). The sensitivity, specificity, rate of missed diagnosis and misdiagnosis rate of MRI-DWI in the differential diagnosis of spinal tuberculosis and spinal metastatic tumor were 93.55%, 93.75%, 6.45% and 6.25%, respectively, and the diagnostic kappa value was 0.871. Conclusion MRI-DWI has a high sensitivity and specificity in the differential diagnosis of spinal tuberculosis and spinal metastases, and the diagnostic results are highly consistent with pathological results.