MRI study of the spread routes of spine tuberculosis <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

李志建　广东省新会人民医院放射科

龙晚生　广东省江门市中心医院放射科研

Abstract

Objective：To study the spread routes and MRI Characteristic of the spine tuberculosis.

Meterials and Methods：31 cases of such cases were selected. Axial, coronal, sagittal  and contrast-enhanced  MRI scan were performed. The numbers and the correlate of involved vertebracs with disc space,  epidural membrane and paraspinal abscess and ligament were evaluated by two doctors.

Results：(1) multiple vertebracs involved were the most commonly. The average number of involved vertebrae was three vertebracs. (2)Single by disc space involvement was seen in 19 cases. (3) 10 cases with epidural. membrane spread. (4)12 cases with paraspinal abscess and ligament spread. (5) Hematogenous seeding was seen in 5 cases. the combination of the more routes often was in a patient.

Conclusion：There were more routes of the involvement of the spine tuberculosis. MRI can accurately show the routes, focuses and limits of the spine tuberculosis.

Key words：Spine; Tuberculosis; Diagnosis; Magnetic; resonance; imaging

脊柱结核的发病率近年来有明显的上升趋势，不典型特殊类型的脊柱结核病亦有增多，而且发现受累椎体的数目通过MRI检查比通过平片和CT检查的要多^[1，2]，文献检索发现对引起不典型特殊类型的脊柱结核和多椎体受累的原因探讨甚少。现回顾性分析从1996年5月至2001年6月我院经手术病理证实的脊柱结核31例MR资料，以探讨结核在脊柱内的播散途径。

材料和方法

男16例，女15例。年龄14岁至81岁，平均45岁。有确切肺结核病史19例。全身症状主要有低热11例，食欲下降5例。局部症状主要有局部疼痛30例，双下肢无力或（和）肌力进行性下降19例。

采用西门子公司生产的Impact1.0T超导机扫描，常规用SE序列行脊柱冠状位、矢状位T1WI、T2WI，T1WI（TR/TE，700/12ms），T2WI(TR/TE，4000/128ms)，层厚3mm，层间距0.3 mm，视野280，矩阵192χ256，激励次数2次。横轴位T1WI（TR/TE，500/15ms）,层厚5mm，层间距0.5 mm。增强扫描用Gd-DTPA按0.1 mmol/kg，一次性静脉团注后，再行横轴位、冠状位、矢状位T1WI成像，所用参数与平扫相同。19例增强后还做了矢状位T1WI脂肪抑制序列。

全部病例均在MR检查后2天至5天行脊柱手术，并经病理确诊为脊柱结核。