結(jié)核性脊柱炎的MRI表現(xiàn)及與CT的對比研究
發(fā)布時間：2019-06-03 10:58
【摘要】：目的： 探討脊柱結(jié)核的MRI表現(xiàn)特點以及對病灶本身細節(jié)進行量化；對比CT平掃、CT重建、MRI影像學(xué)檢查手段對脊柱結(jié)核病灶顯示的優(yōu)勢及其在指導(dǎo)診斷治療中的應(yīng)用。 方法： 回顧性分析佛山市中醫(yī)院2009.02.16-2013.01.30期間收治的共39例經(jīng)手術(shù)和病理證實的脊柱結(jié)核的影像資料。觀察患者MRI圖像,采用德國Siemens1.5T Magnetom Avanto磁共振成像儀,用脊椎專用線圈。常規(guī)矢狀面T1WI、T2WI,軸位和冠狀面T2WI,靜脈注射Gd-DTPA后增強掃描采用T1WI或脂肪抑制T1WI序列。28例同期行CT檢查,采用Philip Mx8000IDT16排螺旋CT,層厚2mm,層距1mm,檢查包括所有病變椎體及上下相鄰椎體,骨窗和軟組織窗顯示圖像。采用Philip4.3后處理工作站處理CT重建圖像。在椎體病變、椎間盤病變、椎管改變、椎旁膿腫等方面進行影像評估測量,并對評估值進行細致量化。將CT平掃、CT重建、MRI影像學(xué)檢查手段對脊柱結(jié)核病灶顯示進行評分并作統(tǒng)計學(xué)分析,對比其各自優(yōu)勢。 成果： 39例接受檢查的病患中累及頸椎1例,胸椎16例,累及胸腰椎8例,腰椎13例,骶椎1例；同期行CT和MRI兩種影像檢查手段的28例病患中,累及胸椎的占28.6%,腰椎的占50%,累及胸腰椎的占2I.4%。除1例單椎體受累外,其余38例病患均有兩個或兩個以上椎體受累,其中兩個椎體受累24例,三個及以上14例(最常累及T5-L1)。 本組樣本CT平掃、CT重建(MPR)和MRI顯示脊柱結(jié)核病變的敏感性分別為76%、86%和100%。應(yīng)用四格表卡方檢驗比較,結(jié)果表明CT與MRI之間X2=22.703,p0.05,差異具統(tǒng)計學(xué)意義；CT與MPR之間X2=3.204,p中0.05,差異不具統(tǒng)計學(xué)意義：MPR與MRI之間X2=11.771,p0.05,差異具統(tǒng)計學(xué)意義。因此脊柱結(jié)核的顯示敏感性MRI比CT、MPR好。此外,在顯示椎體破壞方面, MPR、MRI較之CT有優(yōu)勢,MPR和MRI對比差異不顯著；在顯示椎間盤病變、椎管改變、椎旁膿腫方面,MRI較之CT、MPR更有優(yōu)勢；而在判斷骨硬化、死骨形成、膿腫及軟組織鈣化方而,CT、MPR較之MRI優(yōu)勢顯著。 對比各種醫(yī)學(xué)影像學(xué)手段,MRI的優(yōu)勢明顯,一是其軟組織對比分辨率最高,它可以清楚地分辨脊柱周圍肌肉、肌腱、筋膜、脂肪、膿腫等軟組織,可全面顯示脊柱結(jié)構(gòu)并直接做出橫斷面、失狀面、冠狀而和各種斜面的體層圖像,以便進行解剖結(jié)構(gòu)或病變的立體追蹤。二是MRI成像參數(shù)多,包含信息量大,MRI的成像潛力巨大,為臨床應(yīng)用提供廣闊的研究領(lǐng)域。三是MRI顯示疾病的病理過程較廣泛,常常能更有效和更早地發(fā)現(xiàn)病變,它能非常清晰地顯示脊髓的灰質(zhì)和白質(zhì),不受骨像干擾,故在脊柱神經(jīng)系統(tǒng)病變方面有較高的診斷價值。因此,MRI較之CT和MPR在顯示椎間盤病變、椎管改變、椎旁膿腫方面的顯著優(yōu)勢；在顯示這些骨組織退變后的改變對脊髓神經(jīng)根的壓迫方面,MRI亦優(yōu)于CT。 然而鈣化灶內(nèi)不含質(zhì)子,不產(chǎn)生MR[信號,故MRI對鈣化不敏感,小鈣化灶由于容積效應(yīng)不能顯示,大的鈣化灶表現(xiàn)為無信號區(qū)亦缺乏特異性。鈣化在發(fā)現(xiàn)病變和定性診斷上有幫助,所以在這方面CT和MPR則體現(xiàn)了其優(yōu)勢,在觀察頸椎骨刺、韌帶鈣化及椎管狹窄等骨組織的退變情況時,優(yōu)于MRI。此外,MPR能將掃描范圍內(nèi)所有的軸位圖像疊加起來,再對某些標線標定的重組線所指定的組織進行冠狀、矢狀位、任意角度斜位圖像重組。MPR的優(yōu)點主要體現(xiàn)在三個方面：一是能任意產(chǎn)生新的斷層圖像,而無需重復(fù)掃描；二是原圖像的密度值被忠實保持到結(jié)果圖像上；三是曲面重組能在一幅圖像里展開顯示彎曲物體的全長。因此在檢查脊椎時,往往軸切面的影像只限于有時才能顯出椎體,也無法完全顯示出椎間盤,而應(yīng)用MPR使我們可以更容易觀察出脊椎的位置以及其和其他器官的關(guān)系；這從技術(shù)的層而解釋了CT與MPR在統(tǒng)計結(jié)果里顯示的椎間盤改變特征差異化的原因。同時,MPR的缺點則體現(xiàn)在難以表達復(fù)雜的空間結(jié)構(gòu)和曲面重組易造成假陽性兩個方面,我們也可以據(jù)此解釋MPR與MRI在后突畸形特征方面的無差異統(tǒng)計結(jié)果。 結(jié)論： (1)脊柱結(jié)核的影像學(xué)表現(xiàn)與其病理變化是相關(guān)聯(lián)的；對于CT平掃、CT重建不明顯的早期病變,MRI即可清晰顯示其出現(xiàn)的受累脊椎及椎旁軟組織信號改變等情況。(2)結(jié)核性脊柱炎的典型CT平掃、CT重建表現(xiàn)為：椎體破壞且始于椎體邊緣、死骨形成、局限性溶骨、椎旁膿腫壁及軟組織鈣化,較嚴重病例可累及肋骨。結(jié)核性脊柱炎的典型MRI表現(xiàn)為：椎體破壞、椎體或后部附件均可單獨受累(較嚴重病例可累及肋骨)、椎間盤改變、椎旁軟組織影及硬膜囊和脊髓改變。腰大肌膿腫及軟組織鈣化可作為診斷結(jié)核性脊柱炎的影像線索。椎(?)膿腫的大小與椎體破壞程度或臨床癥狀程度不成比例。CT平掃、CT重建能較好地顯示出脊柱結(jié)核的破壞范圍以及其細微鈣化,而MRI則很好地顯示出脊柱結(jié)核的侵犯范圍以及所有組織病變。(3)不同影像學(xué)手段對脊柱結(jié)核病灶顯示各具優(yōu)勢,不能完全相互替代,需將這些檢查相互結(jié)合才能提高脊柱結(jié)核的診斷,對臨床制定治療方案具有重要的參考價仇。
[Abstract]:Purpose: To study the MRI features of spinal tuberculosis and to quantify the details of the focus, and to compare the advantages of CT, CT, MRI and MRI in the diagnosis and treatment of spinal tuberculosis. For use. Methods: A total of 39 cases of spinal tuberculosis confirmed by operation and pathology were analyzed retrospectively. The image data of the patient was observed. The MRI image of the patient was observed, using a German Siemens 1. 5T Magnetom Avanto magnetic resonance imager and a ridge. T1WI, T2WI, axial and coronal T2WI, and Gd-DTPA enhanced scan were performed with T1WI or fat to inhibit the T1WI sequence. The CT of 28 patients was performed in the same period. The CT was performed with Philip Mx8000IDT16, with a layer thickness of 2 mm and a layer interval of 1 mm. The examination included all the diseased vertebral bodies and the upper part. Lower adjacent vertebral body, bone window and soft tissue Window display image. Process C using the Philip 4.3 post-processing workstation The image was reconstructed in the aspects of vertebral body lesion, disc lesion, spinal canal change, and paravertebral abscess. The CT plain scan, CT reconstruction and MRI imaging examination were used to score and compare the display of the spinal tuberculosis. each of which The results:1 case of cervical vertebra,16 cases of thoracic vertebra,8 cases of thoracic and lumbar vertebra,13 cases of lumbar vertebra and 1 case of cervical vertebra were involved in 39 cases of examination. % of the lumbar,50% of the lumbar spine, involving the chest The lumbar vertebrae accounted for 2I.4%. In addition to one single vertebral body involvement, the remaining 38 patients had two or more vertebral body involvement, including 24 cases, three or more 14 cases (most The sensitivity of CT plain scan, CT reconstruction (MPR) and MRI in the diagnosis of spinal tuberculosis was 7. The results showed that X2 = 22.703, p0.05 in CT and MRI, and the difference was not significant between CT and MPR: X2 = 11.771, p0 between MPR and MRI. 05. The difference is of statistical significance. Therefore, the display sensitivity of spinal tuberculosis The MRI is better than CT and MPR. In addition, in the aspect of displaying the destruction of the vertebral body, the MPR and MRI have the advantages of comparing with the CT, and the contrast between the MPR and the MRI is not significant; in the aspect of displaying the disc lesion, the spinal canal change and the paravertebral abscess, the MRI is more advantageous than the CT and the MPR; and in the judgment of the bone hardening, the forming of the dead bone , Abscess and Soft Tissue Calcification, CT, M Compared with MRI, the advantage of MRI is that the contrast resolution of soft tissue is the highest, and it can clearly distinguish the soft tissue, such as muscle, tendon, fascia, fat, abscess and other soft tissues around the spinal column. a layer image that is configured and directly made in cross-section, out-of-form, coronal, and various inclined planes, so as to The second is the imaging parameters of the MRI, including the large amount of information, and the imaging potential of the MRI is huge. The third is that the pathological process of MRI shows that the pathological process of the disease is wide, it is often more effective and early to find the lesion, it can show the gray matter and the white matter of the spinal cord very clearly, and is not disturbed by the bone image, so it is in the spinal nerve system There is a high diagnostic value in the pathological aspect of the system. Therefore, the MRI is superior to that of the CT and MPR in the display of the disc lesion, the spinal canal changes and the paravertebral abscess, and the change of the bone tissue degeneration to the spinal nerve root after the degeneration of the bone tissue is shown. In the aspect of compression, MRI is also superior to CT. However, no proton is present in the calcified range, and MR[signal is not generated, so the MRI is not sensitive to calcification, and the small calcified range cannot be displayed due to the volume effect and large calcium There is also a lack of specificity in the signal-free area. Calcification is helpful in the discovery of lesions and qualitative diagnosis, so the CT and MPR in this respect reflect its advantages in the observation of the cervical spine, the calcification of the ligamentum and the spinal stenosis. In addition, MPR is superior to MRI in the case of the degeneration of bone tissue. In addition, the MPR can superpose all the axial images in the scan range, and then perform the coronary on the tissue designated by the recombinant line that is calibrated by some reticles. the advantages of the MPR are mainly embodied in three aspects: firstly, a new fault image can be arbitrarily generated without repeated scanning; secondly, the density value of the original image is faithfully kept on the result image; and thirdly, the surface recombination can be carried out in one step, The full length of the curved object is displayed in the image. Therefore, in the examination of the spine, the image of the axial section is limited to sometimes the vertebral body, and the disc can not be fully displayed, and the application of MPR makes it easier to observe the ridge. The position of the vertebra, as well as its relationship with other organs; this explains the display of the CT and MPR in the statistical results from the layer of the technique At the same time, the defect of MPR is that it is difficult to express the complex spatial structure and the surface recombination is easy to cause false positive two aspects, and we can also explain the MPR and MRI at the same time deformity of process Conclusion: (1) The imaging performance of spinal tuberculosis is associated with its pathological changes. The typical CT and CT reconstruction of the tuberculous spondylitis showed that the vertebral body was damaged and started at the edge of the vertebral body, the formation of the dead bone, the limitation of the osteolytic bone and the paravertebral pus. Calcification of the wall and soft tissue, the more serious case may involve the rib. The typical MRI of the tuberculous spondylitis is: the vertebral body is damaged, the vertebral body or the posterior accessory can be affected separately (the more serious case may involve the rib), the intervertebral body Changes of disc, paravertebral soft tissue and subdural sac and spinal cord changes. Abscess of the lumbar muscle and soft group Calcification can As an image clue to the diagnosis of tuberculous spondylitis, the size of the abscess of the vertebra (?) Small to the degree of destruction of the vertebral body or to the degree of clinical symptoms. CT scanning and CT reconstruction can well show the extent of the destruction of the spinal tuberculosis and the fine calcification of the spinal tuberculosis, and the MRI is very good. The scope of the invasion and all the pathological changes of the spinal tuberculosis are shown. (3) The different imaging methods have different advantages to the spinal tuberculosis range, which can not be replaced completely, and the examination should be combined to improve the diagnosis of spinal tuberculosis.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R274.9;R445.2;R816.8
本文編號：2491890
[Abstract]:Purpose: To study the MRI features of spinal tuberculosis and to quantify the details of the focus, and to compare the advantages of CT, CT, MRI and MRI in the diagnosis and treatment of spinal tuberculosis. For use. Methods: A total of 39 cases of spinal tuberculosis confirmed by operation and pathology were analyzed retrospectively. The image data of the patient was observed. The MRI image of the patient was observed, using a German Siemens 1. 5T Magnetom Avanto magnetic resonance imager and a ridge. T1WI, T2WI, axial and coronal T2WI, and Gd-DTPA enhanced scan were performed with T1WI or fat to inhibit the T1WI sequence. The CT of 28 patients was performed in the same period. The CT was performed with Philip Mx8000IDT16, with a layer thickness of 2 mm and a layer interval of 1 mm. The examination included all the diseased vertebral bodies and the upper part. Lower adjacent vertebral body, bone window and soft tissue Window display image. Process C using the Philip 4.3 post-processing workstation The image was reconstructed in the aspects of vertebral body lesion, disc lesion, spinal canal change, and paravertebral abscess. The CT plain scan, CT reconstruction and MRI imaging examination were used to score and compare the display of the spinal tuberculosis. each of which The results:1 case of cervical vertebra,16 cases of thoracic vertebra,8 cases of thoracic and lumbar vertebra,13 cases of lumbar vertebra and 1 case of cervical vertebra were involved in 39 cases of examination. % of the lumbar,50% of the lumbar spine, involving the chest The lumbar vertebrae accounted for 2I.4%. In addition to one single vertebral body involvement, the remaining 38 patients had two or more vertebral body involvement, including 24 cases, three or more 14 cases (most The sensitivity of CT plain scan, CT reconstruction (MPR) and MRI in the diagnosis of spinal tuberculosis was 7. The results showed that X2 = 22.703, p0.05 in CT and MRI, and the difference was not significant between CT and MPR: X2 = 11.771, p0 between MPR and MRI. 05. The difference is of statistical significance. Therefore, the display sensitivity of spinal tuberculosis The MRI is better than CT and MPR. In addition, in the aspect of displaying the destruction of the vertebral body, the MPR and MRI have the advantages of comparing with the CT, and the contrast between the MPR and the MRI is not significant; in the aspect of displaying the disc lesion, the spinal canal change and the paravertebral abscess, the MRI is more advantageous than the CT and the MPR; and in the judgment of the bone hardening, the forming of the dead bone , Abscess and Soft Tissue Calcification, CT, M Compared with MRI, the advantage of MRI is that the contrast resolution of soft tissue is the highest, and it can clearly distinguish the soft tissue, such as muscle, tendon, fascia, fat, abscess and other soft tissues around the spinal column. a layer image that is configured and directly made in cross-section, out-of-form, coronal, and various inclined planes, so as to The second is the imaging parameters of the MRI, including the large amount of information, and the imaging potential of the MRI is huge. The third is that the pathological process of MRI shows that the pathological process of the disease is wide, it is often more effective and early to find the lesion, it can show the gray matter and the white matter of the spinal cord very clearly, and is not disturbed by the bone image, so it is in the spinal nerve system There is a high diagnostic value in the pathological aspect of the system. Therefore, the MRI is superior to that of the CT and MPR in the display of the disc lesion, the spinal canal changes and the paravertebral abscess, and the change of the bone tissue degeneration to the spinal nerve root after the degeneration of the bone tissue is shown. In the aspect of compression, MRI is also superior to CT. However, no proton is present in the calcified range, and MR[signal is not generated, so the MRI is not sensitive to calcification, and the small calcified range cannot be displayed due to the volume effect and large calcium There is also a lack of specificity in the signal-free area. Calcification is helpful in the discovery of lesions and qualitative diagnosis, so the CT and MPR in this respect reflect its advantages in the observation of the cervical spine, the calcification of the ligamentum and the spinal stenosis. In addition, MPR is superior to MRI in the case of the degeneration of bone tissue. In addition, the MPR can superpose all the axial images in the scan range, and then perform the coronary on the tissue designated by the recombinant line that is calibrated by some reticles. the advantages of the MPR are mainly embodied in three aspects: firstly, a new fault image can be arbitrarily generated without repeated scanning; secondly, the density value of the original image is faithfully kept on the result image; and thirdly, the surface recombination can be carried out in one step, The full length of the curved object is displayed in the image. Therefore, in the examination of the spine, the image of the axial section is limited to sometimes the vertebral body, and the disc can not be fully displayed, and the application of MPR makes it easier to observe the ridge. The position of the vertebra, as well as its relationship with other organs; this explains the display of the CT and MPR in the statistical results from the layer of the technique At the same time, the defect of MPR is that it is difficult to express the complex spatial structure and the surface recombination is easy to cause false positive two aspects, and we can also explain the MPR and MRI at the same time deformity of process Conclusion: (1) The imaging performance of spinal tuberculosis is associated with its pathological changes. The typical CT and CT reconstruction of the tuberculous spondylitis showed that the vertebral body was damaged and started at the edge of the vertebral body, the formation of the dead bone, the limitation of the osteolytic bone and the paravertebral pus. Calcification of the wall and soft tissue, the more serious case may involve the rib. The typical MRI of the tuberculous spondylitis is: the vertebral body is damaged, the vertebral body or the posterior accessory can be affected separately (the more serious case may involve the rib), the intervertebral body Changes of disc, paravertebral soft tissue and subdural sac and spinal cord changes. Abscess of the lumbar muscle and soft group Calcification can As an image clue to the diagnosis of tuberculous spondylitis, the size of the abscess of the vertebra (?) Small to the degree of destruction of the vertebral body or to the degree of clinical symptoms. CT scanning and CT reconstruction can well show the extent of the destruction of the spinal tuberculosis and the fine calcification of the spinal tuberculosis, and the MRI is very good. The scope of the invasion and all the pathological changes of the spinal tuberculosis are shown. (3) The different imaging methods have different advantages to the spinal tuberculosis range, which can not be replaced completely, and the examination should be combined to improve the diagnosis of spinal tuberculosis.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R274.9;R445.2;R816.8
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