MRI在布鲁氏菌病患者早期脊柱炎与ModicⅠ型脊柱退行性病变的鉴别诊断价值

doi:10.19871/j.cnki.xfcrbzz.2024.06.005

新发传染病电子杂志 ›› 2024, Vol. 9 ›› Issue (6): 26-31.doi: 10.19871/j.cnki.xfcrbzz.2024.06.005

MRI在布鲁氏菌病患者早期脊柱炎与ModicⅠ型脊柱退行性病变的鉴别诊断价值

李俊林¹, 丁海涛², 王丽娜³, 尹松涛¹, 赵楠¹

1.内蒙古自治区人民医院影像医学科,内蒙古呼和浩特 010017;
2.内蒙古自治区人民医院临床检验医学中心,内蒙古呼和浩特市 010017;
3.内蒙古自治区人民医院超声医学科,内蒙古呼和浩特 010017

收稿日期:2024-10-08 出版日期:2025-01-25 发布日期:2025-01-25
通讯作者: 丁海涛,Email：htding2013@163.com
基金资助:
1.内蒙古医学科学院公立医院科研联合基金科技项目(2023GLLH0060); 2.内蒙古自治区卫生健康委医疗卫生科技计划项目(202201054); 3.内蒙古自治区医师协会临床医学研究和临床新技术推广项目（YSXH2024KYF001）

The value of MRI in differentiating Modic type Ⅰspinal degenerative changes from early spondylitis in patients with brucellosis

Li Junlin¹, Ding Haitao², Wang Lina³, Yin Songtao¹, Zhao Nan¹

1. Department of Imaging Medical, The People's Hospital of Inner Mongolia Autonomous Region, Inner Mongolia Hohhot 010017, China;
2. Department of Region Clinical medical laboratory centerThe People's Hospital of Inner Mongolia Autonomous, Inner Mongolia Hohhot 010017, China;
3. Department of Ultrasound, The People's Hospital of Inner Mongolia Autonomous Region, Inner Mongolia Hohhot 010017, China

Received:2024-10-08 Online:2025-01-25 Published:2025-01-25

摘要/Abstract

摘要： 目的探讨MRI在布鲁氏菌病患者早期脊柱炎与ModicⅠ型脊柱退行性病变鉴别中的应用价值,为二者的鉴别诊断提供影像学参考依据。方法选取内蒙古自治区人民医院2020年1月至2024年5月期间收治的15例确诊为布鲁氏菌性脊柱炎（brucellosis spondylitis,BS）患者作为BS组,17例腰椎ModicⅠ型脊柱退行性病变（Modic type Ⅰspinal degenerative changes,MⅠ）患者作为MⅠ组,所有患者均行MRI检查,分别比较两组病变椎体及邻近椎间盘的形态、信号、骨质改变、强化的影像模式。结果 BS组15例患者病变共累及椎体28个,平均年龄47.88岁;MⅠ组17例患者病变共累及椎体27个,平均年龄53.60岁。BS组病变好发椎体：L₄,占比28.57%（8/28）;病灶以T₁WI低信号（13/28,46.43%）、T₂WI边界清楚（24/28,85.71%）、T₁WI终板轮廓线不连续（24/28,85.71%）为主;未发现DWI爪征阳性;MRI增强扫描病灶发生强化100%（17/17）;部分椎体存在骨质破坏10.71%（3/28）;病灶大部分为扇形或条形形态（23/28,82.14%）;椎间盘T₂WI高信号占83.33%（15/18）。MⅠ组病变好发椎体：L₅,占比33.33%（9/27）,病灶以T₁WI等低信号（18/27,66.67%）、T₂WI边界模糊（18/27、66.67%）、T₁WI终板轮廓线连续（22/27、81.48%）为主;T₁WI高信号的发生率11.11%（3/27）;DWI爪征阳性100.00%（7/7）;MRI增强扫描病灶发生强化100.00%（7/7）;部分椎体存在骨质破坏14.81%（4/27）;病灶扇形或条形形态为62.96%（17/27）;椎间盘T₂WI高信号占比20.00%（3/15）。结论 DWI爪征阳性,明确提示MⅠ;T₁WI终板轮廓线连续,MⅠ可能性大;累及椎间盘T₂WI高信号,BS可能性大;病灶中出现T₁WI高信号,提示MⅠ。以上特征对布鲁氏菌病患者早期脊柱炎与MⅠ的鉴别诊断有意义;病灶的形态和强化对二者的鉴别诊断价值不大,不推荐作为鉴别指标。

关键词: 布鲁氏菌病, 脊柱炎, ModicⅠ型脊柱退行性病变, 磁共振

Abstract: Objective To explore the application value of MRI in the differential diagnosis of early spondylitis in brucellosis patients and Modic typeⅠ spinal degeneration, and to provide imaging reference for the differential diagnosis of the two. Method Fifteen patients diagnosed with early brucellosis spondylitis admitted to the People's Hospital of Inner Mongolia Autonomous Region from January 2020 to May 2024 were selected as the BS group, and 17 patients with lumbar Modic type Ⅰ spinal degeneration were selected as the MⅠ group. All patients underwent MRI examination. The morphology, signal, bone change and enhanced image pattern of the diseased vertebral body and adjacent discs of the two groups were compared respectively. Result The 15 patients in BS group had 28 vertebral body lesions, with an average age of 47.88 years. A total of 27 vertebral bodies were involved in 17 patients in MⅠ group with an average age of 53.60 years. Vertebrae prone to lesions in BS group: L4, accounting for 28.57% (8/28); The lesions were mainly characterized by hypointense on T₁WI (13/28, 46.43%), clear boundary on T₂WI (24/28, 85.71%) and discontinuous end-plate contour on T₁WI (24/28, 85.71%). No positive DWI claw sign was found. Lesion enhancement 100% (17/17); 10.71% (3/28) of the vertebral bodies had bone destruction. Most lesions were fan-shaped or stripe-shaped (23/28, 82.14%). T₂WI hyperintensity of intervertebral disc was 83.33% (15/18). In MⅠ group, the lesion was L5, accounting for 33.33% (9/27), and the lesion was mainly iso-hypointensity such as T₁WI (18/27, 66.67%). The incidence of hyperintense in T₁WI was 11.11% (3/27). The main lesions were blurred boundary on T₂WI (18/27, 66.67%) and continuous endplate contour on T₁WI (22/27, 81.48%). DWI claw positive 100% (7/7); Lesion enhancement 100% (7/7); Some vertebrae had bone destruction 14.81% (4/27); Segment or strip shape of the lesion 62.96% (17/27). Intervertebral disc T₂WI hyperintense accounted for 20.00% (3/15). Conclusion :DWI claw sign is positive, indicating MⅠ clearly. T₁WI endplate contour is continuous, MⅠ possibility is high; Involved intervertebral disc T2WI hyperintense, BS is more likely; T₁WI hyperintense appeared in the lesion, indicating MⅠ. The above features are significant for the differential diagnosis of early spondylitis in brucellosis patients and ModicⅠspinal degeneration. Lesion morphology and enhancement have little value in the differential diagnosis of the two, and are not recommended as differential indicators.

Key words: Brucellosis, Spondylitis, Modic typeⅠspinal degeneration, Magnetic resonance imaging

中图分类号:

R378.5

李俊林, 丁海涛, 王丽娜, 尹松涛, 赵楠. MRI在布鲁氏菌病患者早期脊柱炎与ModicⅠ型脊柱退行性病变的鉴别诊断价值[J]. 新发传染病电子杂志, 2024, 9(6): 26-31.

Li Junlin, Ding Haitao, Wang Lina, Yin Songtao, Zhao Nan. The value of MRI in differentiating Modic type Ⅰspinal degenerative changes from early spondylitis in patients with brucellosis[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(6): 26-31.

参考文献

[1] 中国防痨协会骨关节结核专业分会, 中国华北骨结核联盟, 中国西部骨结核联盟. 布鲁氏菌性脊柱炎诊断及治疗专家共识[J]. 中国防痨杂志, 2022, 44(6): 531-538.
[2] PU ZS, LIU YW, BAI ML, et al. Association Between Diagnostic Delays and Spinal Involvement in Human Brucellosis: A Retrospective Case-Control Study[J]. Open Forum Infect Dis, 2024, 11(7):ofae357.
[3] DE ROOS A, KRESSEL H, SPRITZER C, et al.MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease[J]. Am J Roentgenol, 1987, 149(3): 531-534.
[4] RAHME R, MOUSSA R.The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine[J]. Am J Neuroradiol, 2008, 29(5): 838-842.
[5] YASIN P, YIMIT Y, ABLIZ D, et al.MRI-based interpretable radiomics nomogram for discrimination between Brucella spondylitis and Pyogenic spondylitis[J]. Heliyon,2024,10(1) : e23584.
[6] 李会侠, 王祺, 张建中, 等. 磁共振成像对布氏杆菌性脊柱炎诊断的临床应用价值[J]. 中华医学杂志, 2019, 99(37):2935-2938.
[7] 郭辉, 张铁亮, 刘文亚. 《影像学诊断布鲁氏菌性脊柱炎专家共识》解读[J/CD]. 新发传染病电子杂志, 2023, 8(5): 92-96.
[8] KARAYOL SS, KARAVOL KC.Does diffusion-weighted magnetic resonance imaging have a place in the differential diagnosis of brucella sacroiliitis and seronegative spondyloarthropathy?[J]. Acta Radiologica, 2021, 62(6):752-757.
[9] ZHANG C, LIU S.The advancement of MRI in differentiating Modic type I degenerative changes from early spinal infections[J]. Br J Radiol, 2023, 96(1152):20230551.
[10] CHELLI BOUAZIZ M, LADEB M, CHAKROUN M, et al.Spinal brucellosis: a review[J]. Skeletal Radiology, 2008, 37(9):785-790.
[11] 李俊林, 王丽娜, 张晓琴. 布鲁氏菌性脊柱炎影像模式及特征分析[J/CD]. 新发传染病电子杂志, 2021, 6(4): 331-335.
[12] ADAMS MA, FREEMAN BJ, MORNSON HP, et al.Mechanical imitation of intervertebraI disc degeneration[J].Spine, 2000,25(13):1625-1636.
[13] 李葳, 赵英华, 刘金, 等. 布鲁氏菌性脊柱炎与结核性脊柱炎的影像学鉴别诊断[J]. 中华医学杂志, 2018, 98(29): 2341-2345.
[14] MODIC MT, STEINBERG PM, ROSS JS, et al.Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging[J]. Radiology, 1988, 166(1 Pt 1): 193-199.
[15] ARAJ GF.Human brucellosis: a classical infectious disease with persistent diagnostic challenges[J]. Clin Lab Sci, 1999, 12(4): 207-212.
[16] YEOM JA, LEE IS, SUH HB, et al.Magnetic Resonance Imaging Findings of Early Spondylodiscitis: Interpretive Challenges and Atypical Findings[J]. Korean J Radiol, 2016, 17(5): 565-580.
[17] DUNBAR JA, SANDOE JA, RAO AS, et al.The MRI appearances of early vertebral osteomyelitis and discitis[J]. Clin Radiol, 2010, 65(12): 974-981.
[18] ABULIZI Y, CAI XY, XU T, et al.Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis[J]. J Vis Exp, 2021, 2021(171):e61840.
[19] NGUYEN C, POIRAUDEAU S, RANNOU F.From Modic 1 vertebral-endplate subchondral bone signal changes detected by MRI to the concept of 'active discopathy'[J]. Ann Rheum Dis, 2015, 74(8): 1488-1494.
[20] KUMAR Y, GUPTA N, CHHABRA A, et al.Magnetic resonance imaging of bacterial and tuberculous spondylodiscitis with associated complications and non-infectious spinal pathology mimicking infections: a pictorial review[J]. BMC Musculoskelet Disord, 2017, 18(1): 244.
[21] MORALES H.Infectious Spondylitis Mimics: Mechanisms of Disease and Imaging Findings[J]. Semin Ultrasound CT MR, 2018, 39(6): 587-604.
[22] RAGHAVAN M, LAZZERI E, PALESTRO CJ.Imaging of Spondylodiscitis[J]. Semin Nucl Med, 2018, 48(2): 131-147.
[23] PATEL KB, POPLAWSKI MM, PAWHA PS, et al.Diffusion-weighted MRI "claw sign" improves differentiation of infectious from degenerative modic type 1 signal changes of the spine[J]. Am J Neuroradiol, 2014, 35(8): 1647-1652.

MRI在布鲁氏菌病患者早期脊柱炎与ModicⅠ型脊柱退行性病变的鉴别诊断价值

The value of MRI in differentiating Modic type Ⅰspinal degenerative changes from early spondylitis in patients with brucellosis

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	尹松涛, 丁海涛, 李俊林, 张晓琴, 赵楠, 马宇婷. 基于临床及生物学检查的布鲁氏菌性脊柱炎MRI征象分析[J]. 新发传染病电子杂志, 2024, 9(6): 32-35.
[2]	王毅翔, 姚殿琦, 李才应, 肖本亨, Akmal Sabarudin, Giuseppe Guglielmi. 磁共振弥散成像血管密度：概念及潜在多种临床应用[J]. 新发传染病电子杂志, 2024, 9(6): 36-41.
[3]	古晓利, 潘秋合, 陈建波, 郭青. 双能量CT增强与磁共振弹性成像联合诊断慢性乙型肝炎肝纤维化的临床价值[J]. 新发传染病电子杂志, 2024, 9(3): 56-60.
[4]	梁瑞云, 任会丽, 黎惠如, 李城城, 方伟军, 宋敏, 张晖. 脑实质结核增强MRI细节表现研究及与脑转移瘤的对比分析[J]. 新发传染病电子杂志, 2023, 8(5): 29-35.
[5]	郭辉, 张铁亮, 刘文亚. 《影像学诊断布鲁氏菌性脊柱炎专家共识》解读[J]. 新发传染病电子杂志, 2023, 8(5): 92-96.
[6]	黎惠如, 方伟军, 高振华, 刘曾维, 谢智恩. 磁共振成像在布鲁氏菌性脊柱炎与脊柱结核的鉴别诊断价值[J]. 新发传染病电子杂志, 2023, 8(3): 44-48.
[7]	任美吉, 李莉, 赵晶, 齐石, 李宏军. 艾滋病合并进行性多灶性脑白质病的MRI表现[J]. 新发传染病电子杂志, 2023, 8(2): 23-27.
[8]	史延斌, 曾莹婷, 李逸攀, 宋璐, 鲁植艳. 原发性中枢神经系统淋巴瘤在免疫功能正常或低下患者的MRI成像特征[J]. 新发传染病电子杂志, 2023, 8(2): 39-44.
[9]	尹松涛, 李俊林, 张晓琴, 丁海涛, 王占国. 布氏菌病影像学研究进展[J]. 新发传染病电子杂志, 2023, 8(2): 86-90.
[10]	康斌, 高月琴, 熊维, 郑海燕, 江敏, 刘素芳, 黎慧灵, 张娜, 侯可可. 结核性缩窄性心包炎多参数心脏磁共振表现1例报道[J]. 新发传染病电子杂志, 2023, 8(1): 71-73.
[11]	周艳妮, 赵建华. 布鲁氏菌性脊柱炎的MRI研究进展[J]. 新发传染病电子杂志, 2023, 8(1): 82-86.
[12]	杜艳妮, 吕志彬, 邢玉雪, 关春爽, 张紫欣, 谢汝明, 陈步东. 乙型肝炎背景下肝细胞癌钆塞酸二钠增强MRI与组织学分化程度相关性分析[J]. 新发传染病电子杂志, 2022, 7(4): 47-52.
[13]	张娜, 江南, 高月琴, 蔡琳, 谢利秋, 谢贤维, 郑海燕, 侯可可. 艾滋病患者心肌损伤的前瞻性心脏磁共振研究[J]. 新发传染病电子杂志, 2022, 7(3): 41-45.
[14]	罗杰棋, 周昀, 巢华, 云永兴, 王展, 鲍晓慧, 郭昂, 郑广平. MAGiC序列在HIV相关神经认知障碍诊断中的应用价值[J]. 新发传染病电子杂志, 2022, 7(3): 55-59.
[15]	任美吉, 李莉, 赵晶, 李宏军. 钆塞酸二钠增强MRI评估乙型病毒性肝炎患者肝脏储备功能的研究[J]. 新发传染病电子杂志, 2022, 7(2): 63-66.