摘要
目的探讨化脓性脊柱炎、胸腰椎结核CT和MRI影像学表现及鉴别诊断价值。方法收集2019年6月—2022年6月四川省绵阳市骨科医院收治的41例化脓性脊柱炎患者与44例胸腰椎结核患者的临床与影像学资料。分析2种疾病病变钙化、密度、骨质破坏位置、类型等影像学特征,以病理结果为金标准,探讨MRI、CT对疾病的鉴别诊断价值。结果CT鉴别诊断出化脓性脊柱炎33例,胸腰椎结核37例,与病理结果一致性一般(Kappa值=0.646,P<0.05);MRI鉴别诊断出化脓性脊柱炎39例,胸腰椎结核41例,与病理结果一致性较高(Kappa值=0.882,P<0.05)。MRI检查鉴别诊断化脓性脊柱炎、胸腰椎结核的敏感度、准确度分别为95.12%、94.12%,明显高于CT检查的80.49%、83.35%,差异均有统计学意义(P<0.05);2种检查方法鉴别诊断的特异度比较,差异无统计学意义(P>0.05)。CT检查结果显示,化脓性脊柱炎患者受累脊椎椎体高度≥正常椎体1/2、椎体破坏区内钙质样高密度影、附件受累≥5个、椎旁异常软组织钙化比例均低于胸腰椎结核患者,椎体虫蚀型骨质破坏、病灶周围骨质伴硬化边比例均高于胸腰椎结核患者,差异均有统计学意义(P<0.05)。MRI检查结果显示,化脓性脊柱炎患者骨质破坏部位为边缘性、骨质破坏类型为肉芽肿、无椎间盘变窄、椎旁病变局限性脓肿、局限椎间盘破坏、无死骨或钙化、无椎体塌陷及成角比例均高于胸腰椎结核患者,差异均有统计学意义(P<0.05);2种疾病患者病变累及节段情况比较,差异无统计学意义(P>0.05)。结论MRI和CT检查均可有效鉴别诊断胸腰椎结核与化脓性脊柱炎,但MRI诊断效能相对更高,结合患者影像学征象和临床特征可进一步为术前诊断提供帮助。
Objective To explore the CT and MRI features and diagnostic value in the differential diagnosis of pyogenic spondylitis and thoracolumbar tuberculosis.Methods Clinical and imaging data of 41 patients with pyogenic spondylitis and 44 patients with thoracolumbar tuberculosis admitted to the Mianyang Orthopedic Hospital from June 2019 to June 2022 were collected.The charac-teristics of calcification,density,location of bone destruction,and type of lesions in the two diseases were analyzed.The diagnostic value of MRI and CT in the differential diagnosis of the diseases was explored using pathological results as the gold standard.Results Overall,33 cases of pyogenic spondylitis and 37 cases of thoracolumbar tuberculosis were found in the differential diagnosis using CT,with a moderate consistency with pathological results(Kappa value=0.646,P<0.05).A total of 39 cases of pyogenic spon-dylitis and 41 cases of thoracolumbar tuberculosis were found in the differential diagnosis using MRI,with a higher consistency with pathological results(Kappa value=0.882,P<0.05).The sensitivity and accuracy of MRI in the differential diagnosis of pyo-genic spondylitis and thoracolumbar tuberculosis were 95.12%and 94.12%,respectively,significantly higher than the 80.49%and 83.35%of CT examination(P<0.05).No statistically significant difference was observed in the specificity of the two examination methods(P>0.05).CT examination results showed that patients with pyogenic spondylitis had vertebral body height involvement of no less than 1/2 of the normal vertebral body,calcium-like high density in the area of bone destruction,involvement of 5 append-ages or more,and lower proportion of abnormal soft tissue calcification around the vertebrae compared to patients with thoracolum-bar tuberculosis.The proportion of vertebral body worm-eaten type bone destruction and sclerosis around the lesion was significantly higher than that of patients with thoracolumbar tuberculosis(P<0.05).MRI examination results showed that the site of bone de-struction in patients with pyogenic spondylitis was marginal,the type of bone destruction was granuloma,there was no interverte-bral disc narrowing,localized abscess around the vertebrae,localized intervertebral disc destruction,no necrosis or calcification,and no vertebral collapse or angular deformity,all of which were significantly higher than those in patients with thoracolumbar tubercu-losis(P<0.05).No statistically significant difference was noted in the segmental involvement of the two diseases(P>0.05).Conclusion Both MRI and CT examinations can effectively differentiate between thoracolumbar tuberculosis and pyogenic spondyli-tis,but MRI has a higher diagnostic efficacy.Combined with the imaging signs and clinical features of patients,this technique can provide further assistance in preoperative diagnosis.
作者
廖云龙
吴春燕
宋君
李国江
Liao Yunlong;Wu Chunyan;Song Jun;Li Guojiang(Department of Radiology,Mianyang Orthopedic Hospital,Mianyang Sichuan 621000,China;Department of Radiology,Mianyang Hospital Affiliated to University of Electronic Science and Technology of China,Mianyang Sichuan 621000,China)
出处
《保健医学研究与实践》
2024年第1期78-83,共6页
Health Medicine Research and Practice
基金
四川省卫生健康委员会科研课题(20PJ12026)。
