Imaging Features of Sporadic Brucella Spondylitis in Yunnan Province
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摘要:
目的 分析云南散发布鲁氏菌性脊柱炎MRI和CT影像特征，旨在提高对该病的诊断水平。 方法 收集昆明理工大学附属安宁市第一人民医院放射医学科2014年1月至2021年11月经临床、实验室检查确诊的布鲁氏菌性脊柱炎患者38例的资料，均为云南本土居民，回顾性分析患者初次就诊MRI、CT检查所获资料（37例MRI检查，26例CT检查，25例同时行MRI及CT检查）。 结果 病例37例（97.4%）累及腰椎，37例（97.4%）为多椎体受累，1例（2.7%）仅表现为椎体后缘脓肿形成；发现病变好发于椎体上下缘，以 L4、5 椎体受累最多见，占 44.7%（17/38）；1例（2.7%）有2个受累椎体变扁，4例（10.5%）伴受累椎体轻度滑脱。35例（92.1%）伴不同程度骨质破坏。36例（94.7%）椎间盘破坏。24例（63.2%）椎旁和/或硬膜外脓肿形成，2例（8.33%）病变椎体周围脓肿形成累及至右侧腰大肌内。 结论 云南散发布鲁氏菌性脊柱炎CT、MRI影像学表现多样，出现死骨、脓肿累及至腰大肌内、仅硬膜外脓肿形成 不能完全排除本病，对临床诊疗具一定有指导意义及参考价值。 Abstract:Objective To compare the clinical significance of brucellosis spondylitis imaging in Yunnan province. Methods The data of 38 patients with Brucella spondylitis confirmed by clinical and laboratory examination in our hospital from January 2014 to November 2021 were collected, all of whom were local residents of Yunnan province. The data obtained from MRI and CT examination of the patients for the first time （37 cases of MRI examination, 26 cases of CT examination, 25 cases of MRI and CT examination at the same time） were retrospectively analyzed. Results In this study, 37 cases （97.4%） were involved in lumbar vertebrae, 37 cases （97.4%） were involved in multiple vertebrae, and 1 case （2.7%） only showed abscess formation at the posterior margin of vertebrae. It was found that the lesions mainly occurred at the upper and lower edges of the vertebral body, and the L4-5 vertebral bodies were most frequently involved, accounting for 44.7% （17/38）. One case （2.7%） had flattening of two affected vertebrae and four cases （10.5%） had mild spondylolisthesis of the affected vertebrae. 35 cases （92.1%） were associated with different degrees of bone destruction. Thirty-six patients （94.7%） suffered intervertebral disc damage. 24 cases （63.2%） had paraspinal and/or epidural abscess, and 2 cases （8.33%） had paraspinal abscess involving the right psoas major muscle. Conclusions The CT and MRI imaging manifestations of sporadic Brucella spondylitis in Yunnan are diverse, and the involvement of dead bone and abscess into the psoas major muscle and epidural abscess formation alone cannot completely exclude the disease. It is of guiding significance and reference value to clinical diagnosis and treatment. -
Key words:
- Brucellosis /
- Spondylitis /
- Computerized Tomography /
- Magnetic Resonance Imagine
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图 1 图1a-1d呈现L4-5椎间盘后缘病变
a：CT矢状面L4-5椎间盘后缘硬膜囊前缘脓肿形成；b：MRI T1WI矢状面L4-5椎间盘后缘硬膜囊前缘脓肿形成；c：MRI增强扫描病灶呈环状强化，脓液不强化；d： MRI T2WI横断位示硬膜囊及神经根受压（如白 ↑ 所示）。
Figure 1. Figure1a-1d shows posterior margin lesion of L4-5 Intervertebral disc
图 2 呈现L3-4椎体病变
a：MRI矢状位T1WI示L3-4椎体片状低信号；b：MRI T2WI横断位椎体边缘骨质增生硬化，新生骨出现，新生骨内又见新破坏灶，呈典型的“花边椎”；c：分别示CT横断位椎体边缘骨质增生硬化，新生骨出现，新生骨内又见新破坏灶，呈典型的“花边椎”。
Figure 2. Figure 2a-2c shows lesions of the L3-4 vertebral bodies
图 3 L2-3椎体病变
a：MRI矢状位T2WI示L2-3椎体上下缘呈“许莫氏结节样”骨质破坏，受累的髓核T2WI呈稍高信号“裂隙征”（如白 ↑ 所示）；b：MRI矢状位STIR 示L2-3椎体片状高信号骨髓水肿征象；c：MRI T2WI横断位许莫氏结节样骨质破坏；d：CT横断面死骨形成。
Figure 3. shows lesions of the L2-3 vertebral bodies
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