评估X、CT及MRI在脊柱包虫病诊断中的价值

目的 回顾性分析25例脊柱包虫病的临床表现和影像特点,探讨其诊断及误诊原因.方法 1957年10月至2006年6月收治5721例包虫病中,脊柱包虫病患者25例,男14例,女11例,年龄15-56 岁,平均28.3岁,病史0.5-12 年,平均3.2年.发病部位:颈椎3例,胸椎11例,腰椎5例,骶骨6例.从临床、流行病学、影象学及免疫学等方面综合分析,总结其影像学特点及误诊原因.结果 25例脊柱包虫中有23例来自农牧区或有犬羊密切接触史(92%).25例均行X线检查,13例行CT检查,5例(38.46%)诊断包虫.19例行MR检查,17例(89.47%)诊断为包虫病,多房性是本病的特征之一,T1WI母囊信号高于子囊是其另一特征.15例行皮内casoni试验,阳性12例(80%),4例行包虫病八项免疫试验均为阳性.结论 脊柱包虫病X线和CT表现易误诊为结核、转移瘤、骨巨细胞瘤或骨囊肿等,MRI有助于脊柱包虫的诊断与鉴别诊断,血清学检查对确诊诊断有很大帮助.

Evaluation of the value of X、CT and MRI in diagnosis of spinal echinococcosis

Objective To analyze the manifestation and images of spinal echinococcosis retrospectively,and critically examine and elucidate the diagnosis and diagnostic pitfalls of the disease. Methods From October 1957 to June 2006,twenty-five consecutive cases in 5721 cases of echinococcosis collected,which comprised 14 males and 11 females,the average age were 28.3 years(15~56 years). The average duration of infestation with spinal hydatid disease was 3.2 years(0.5~12 years). Nineteen cases underwent MRI scanning. The lesions were located in the cervical vertebrae in 3,the thoracic vertebrae in 11,the lumbar vertebrae in 5 and the sacrum in 6 cases. Results Twenty-three cases in the total(92%)were come from farms or contaminated with dogs and sheep intimately. All the cases were under the examination of X-ray films at first,then CT examination were performed in 13 of the 25 cases and 5 of these were diagnosed as having spinal hydatid disease(38.46%). MRI examination were performed in 19 of the 25 cases and 17 of these were diagnosed as spinal hydatid disease(89.47%). The typical MRI appearance was that of a multilocular cyst and the signal of the parent cyst was similar to that of muscle and higher than that of secondary cyst in the T1 Weighted Image(WI). The Casoni test were performed in 15 cases and positive in 12 patients(80%). In addition,4 cases were positive in all of the so-called 8-tests of immunodiagnostic methods. Conclusion Whereas X-ray or CT images of spinal echinococcosis are similar to tuberculosis,metastases,giant cell tumor,or cyst of bone,MRI shows distinctive diagnostic features of spinal hydatid disease. Serological examinations are important to confirm the correct diagnosis.