| Objective:To study the imaging manifestation of chronic brucellar spondylitis and to improve the clinic diagnosis.Methods:Various imaging parameters(X-ray、spiral CT and MRI) were analyzed in 30 patients with chronic Brucellar Spondylitis proved by clinic or pathology,X-ray、CT and MRI were performed in turn in 28 patients,CT and MRI were performed ordely in 6 patients,2 patients only received MRIscanning.21 cases of 30 patients are from Inner Mongolia and popular area of Zhangjiakou upper dam region, the rest of the 9 cases from Zhangjiakou non-endemic areas under the dam; 18 cases are of Mongolian,12 cases of Han nationality; 15 cases are of pastoralists,8 cases of breeding livestock farmers, cadres in 4 and 3 cases of herdsmen close relatives.In 30 cases of patients, brucellosis chronic joint damage is more outstanding.29 cases suffering brucellosis ever had or have intermittent low-grade fever in past time or seeing a doctor, and the temperature is not more than 38.5 ℃,and these patients were accompanied by lumbar back pain, fatigue, night sweats, some patients with lower limb radiation pain, muscle spasms, spinal motion limitation and limbs joint pain and other symptoms.One patient with abnormal changes of the lumbar spine was found in abdominal CT scan bacause of abdominal discomfort, and then confirmed by serum agglutination test and epidemiological. This group of 30 cases of brinellcoli serum agglutination test are all positive, and the titers are all above 1:160;white blood cell were normal in 23 cases, lymphocyte increased in 28 cases, blood sedimentation reduce in 3 cases,5 cases were associated with liver and spleen enlargement,2 cases showed neurological symptoms (dull, expression indifferent).5patients of 30 underwent surgery, the surgical indications were:3cases with psoas major abscess,1 cases with obvious sciatica, leases with invalid conservative treatment and surgical indications, and these cases were confirmed as spinal brucellosis by postoperative pathology; clinical symptoms of the remaining 25 patients were improves significantly after cured with internal medicine there cases reached the recurred clinical standard noticeably.Results:the disease course of 30 cases was 3 months- 2.5years.We observed the disease evolution of chronic brinellcoli spondylitis in three periods:(1)early period:only 3 cases showed vertebral body bone invasion and destruction in X-ray film. clear and definite morphological changes of bone(marginal, multiple, moth-eaten bone destruction) appeared in 8 cases inCT.8 cases of MR showed the vertebral body and the intervertebral disk signal change, they were long T1 and long 2 signal.2 cases accompanied limiting paravertebral partial side abscess and epidural abscess.there is no clear signs of narrow intervertebral disc and hyperplasia、hardening of vertebral edge,and ligament calcification. (2)Advanced period:22 cases showed clear and definite morphological changes (vertebral bone destruction and reactive new bone) and narrow intervertebral disc, no clear hyperplasia and ligament calcification in X-ray and CT film,these cases had not showed vertebra compression and pathological fracture sign.17 cases of MR showed the homogeneous or uneven low memorial T1 signal and the high signal or no homogeneous high commixture T2 signal in the vertebral body and The uneven signal changes in the intervertebral disk.6 cases showed minor arthritis of vertebra. (3) late period:9 cases of 30 that observed in X-ray and CT film had localized bone destruction and proliferation cirrhosis at the same time; As the disease progresses, hyperplasia of sclerosing have an advantage gradually, partial destruction stove was replaced by new bone,the damage and repair coexisted, narrow intervertebral disc and ligament calcification were always seen, and so on.These cases showed uneven motley appearance outward appearance, form "lip shape " osteophyma because of fleshy calcification of body border periosteum hyperplasia. It can be seen vertebral side ligament ossification like beak sample and adjacent joint surface of vertebral body displayed bone destruction and obvious hyperplasia hardening.5 MR cases appeared a vertebral body signal change.Chronic brucellar spondylitis isdistributed mainly in lumbar vertebra,especially L4. the incidence from T12 to S1 is not exactly the same,the result is:P=0.000, P< a,,then we shall compute pairwise comparison, P-airwise comparison of a requires the use of correction α, α =0.002272727= α/<k(k-1)/2+1>,k=7.the total number of vertebral is 7, th-e number of pairwise comparisons combinations is 21,the incidence of each vertebral is L3>T12,L4>T12,L5>T12,L4>L1,L4>L2,L4>S1.There is no difference of the incidence among other combinations.In these cases,bone destruction is minute and multiple, confined to the vertebral body edge,and obvious proliferation hardening is around the lesions, new bone coexist with destructive bone;disc failure is comparatively slight; adjacent vertebral hyperplasia; fewer or no paraspinal abscess.all patients show bone destruction in varying degrees or merge osteoproliferation hardens in varying periods,29patients show changes of bone in more than two vertebra,5patients accompany periosteum ossify;3cases of 5 showed paravertebral abscess;2cases of 5 showed partial side abscess and epidural abscess.9 patients accompany paraspinal and longitudinal ligament calcification and bone bridge,but no accompanying periosteum ossify.Conclusion; CT scan images without overlapping and with high density resolution is more intuitive to the display of bone destruction and repair, and can observe spinal lesion evolution process, especially the application of MDCT which can multi-directionally reconstruct CT images, can find bone destruction and hyperplasia earlier.MRI is obviously better than X-ray and CT in the early show of the spine brinellcoli lesions,it can find abnormal signals of bone marrow or intervertebral disc before the change in the morphology more sensitively, especially STIR sequence; and because of MRI’s high soft tissue resolution and multi-angle imaging, it can show more clearly the vertebral and epidural abscess, the situation of surrounding soft tissue,display the spinal cord involvement,and affected scope, extent, and so on and so forth more earlier and more clearly than CT and X-ray.MRI and CT imaging is very valuable in the diagnosis and differential diagnoses of brucellar spondylitis, with the epidemiology clinic manifestations and related laboratory testing,we can diagnose correctly brucellar spondylitis. |
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