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目的:探讨CT与MRI在脊柱结核诊断和鉴别诊断中的临床应用价值,为其影像学诊断提供参考。方法:分析本院2011年3月—2013年5月经临床或病理及经抗结核药物治疗证实的56例脊柱结核患者的CT与MRI资料,分析CT与MRI在脊柱结核诊断中的特征。结果:56例脊柱结核病变位于胸椎13例,胸腰段18例,腰椎23例,骶椎2例,患者骨质破坏、椎间盘破坏、附件破坏、椎旁软组织异常、脊髓及硬膜囊表现及增强表现各异。CT与MRI诊断骨质、椎间盘破坏以及椎旁肿块或脓肿的敏感性相近,差异无统计学意义(P>0.05)。MRI对硬膜囊外或椎孔侵犯、附件破坏、韧带下扩散、脊膜强化的诊断敏感性显著高于CT(P<0.05),而CT对钙化的诊断敏感性显著高于MRI(P<0.05)。结论:在脊柱结核的诊断方面,CT和MRI的表现各有优势,CT能清楚地了解椎体骨组织破坏、椎旁脓肿内钙化,而MRI检查可对椎旁软组织内脓肿及脓肿韧带下扩散、附件破坏等部位显示更加清楚。CT与MRI结合检查可全面反映脊柱结核的影像学特征,有利于脊柱结核的诊断和鉴别诊断,对指导临床治疗具有重要的意义。
Objective: To investigate the clinical value of CT and MRI in the diagnosis and differential diagnosis of spinal tuberculosis, and provide a reference for its imaging diagnosis. Methods: CT and MRI data of 56 patients with spinal tuberculosis confirmed by clinical or pathological and antitubercular drug treatment from March 2011 to May 2013 in our hospital were analyzed. The features of CT and MRI in the diagnosis of spinal tuberculosis were analyzed. Results: Fifty-six cases of spinal tuberculosis were found in 13 cases of thoracic spine, 18 cases of thoracolumbar spine, 23 cases of lumbar spine, 2 cases of sacral spine, bone destruction, disruption of intervertebral disc, attachment destruction, paraspinal soft tissue abnormality, spinal cord and dural sac and Enhance the performance of different. There was no significant difference in the sensitivity between CT and MRI in diagnosis of bone, disc destruction and paravertebral mass or abscess (P> 0.05). The sensitivity of MRI to the diagnosis of extradural extracabular or intravertebral foramen invasion, attachment destruction, diffusion under the ligament and meningitis was significantly higher than that of CT (P <0.05), while the sensitivity of CT to the diagnosis of calcification was significantly higher than that of MRI (P < 0.05). Conclusion: CT and MRI have their own advantages in the diagnosis of spinal tuberculosis. CT can clearly understand the destruction of vertebral bone tissue and the calcification of paravertebral abscess. MRI examination can diffuse the paravertebral soft tissue abscess and abscess ligament , Accessories destruction and other parts show more clearly. CT and MRI combined examination can fully reflect the imaging features of spinal tuberculosis, is conducive to the diagnosis and differential diagnosis of spinal tuberculosis, to guide the clinical treatment of great significance.