【原】脊柱感染性疾病和炎症/退变性疾病的鉴别诊断：磁共振的临床价值（九）

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本次文献选自Salaffi F, Ceccarelli L, Carotti M, Di Carlo M, Polonara G, Facchini G, Golfieri R, Giovagnoni A. Radiol Med. 2021 Jun;126(6):843-859.  本次学习由杨聪娴副主任医师主讲。

MRI is the imaging mode of choice and the vertebral bodies and discs typically present hypointense in T1 and hyperintense in T2. Administration of contrast agent can improve sensitivity and specificity particularly in early infections.

MRI为首选成像方式，椎体和椎间盘在T1表现为低信号，T2表现为高信号。使用造影剂可以提高敏感性和特异性，特别是在早期感染中。

Aspergillus

Aspergillus fumigatus is the most frequently isolated species in bone infections. The lumbar region is the main area (63%) of bone involvement, followed by extra-axial regions such as tibia, ribs, wrist, sternum, pelvis and knee. Spondylodiscitis supported by Aspergillus shares several common features with other causes of pyogenic vertebral spondylodiscitis, including male preference, predominance of lumbar involvement, and pain as a symptom of onset.

曲霉属真菌

烟曲霉是骨感染中最常见的真菌。腰椎区是骨受累的主要区域(63%)，其次是中轴骨骼以外区域，如胫骨、肋骨、手腕、胸骨、骨盆和膝关节。曲霉菌引起的脊柱间盘炎与其他化脓性脊柱间盘炎有几个共同特征，包括男性多发、主要累及腰椎以及疼痛为首发症状。

In the presence of an Aspergillus infection, discs lack signal hyperintensity on T2-weighted and STIR images, due to the presence of the paramagnetic and ferromagnetic elements within the fungi and the nuclear cleft may be preserved, a very uncommon finding in pyogenic spondylitis.

在曲霉菌感染的情况下，由于真菌内部存在顺磁性和铁磁性元素，椎间盘在T2WI和压脂像上缺乏高信号，核分裂可能被保留，这在化脓性脊柱炎中非常少见。

As in tuberculosis, subligamentous spread of abscess and multilevel involvement of the spine can be observed and the intervertebral disc may be spared from invasion and inflammatory changes.

与结核一样，可以观察到韧带下脓肿的播散和脊柱的多节段累及，椎间盘可不被累及和炎症改变。

Cryptococcus

Cryptococcus neoformans is the fungus that most commonly causes central nervous system diseases in humans. Spinal involvement occurs in up to 10% of adult cryptococcosis patients, with characteristics similar to those of cold abscesses of tubercular spondylodiscitis. Vertebrae are the most common site of bone involvement in cryptococcosis, the lumbar region being the most affected segment followed by the cervical region.

隐球菌

新型隐球菌是引起人类中枢神经系统疾病的最常见真菌。10%的成人隐球菌病患者会累及脊柱，其特征与结核性脊柱间盘炎的冷脓肿相似。椎体是隐球菌病最常见的骨受累部位，腰椎区是最受影响的节段，其次是颈椎区。

Coccidioidomycosis

Coccidioides immitis causes bone localization in up to 50% of patients with diffuse disease. The most involved articular segments are the spine, ribs and pelvis. Vertebral localizations may involve one or more vertebral bodies, paraspinal tissue and contiguous ribs. Intervertebral discs are relatively spared. Vertebral collapse and fistulae are uncommon late manifestations. In contrast to tuberculosis, in coccidioidomycosis spondylitis the gibbous deformity is not common, although reported. MRI images are not specific, and diagnosis is usually made by biopsy in patients from endemic areas.

球孢子菌病

在多达50%的播散性疾病患者中，球孢子菌累及骨骼。最受累的关节节段是脊柱、肋骨和骨盆。椎体定位可涉及一个或多个椎体、椎旁组织和相邻肋骨。椎间盘相对较少。椎体塌陷和瘘管是罕见的晚期表现。与结核相比，球孢子菌性脊柱炎中后凸畸形并不常见，尽管有报道。MRI图像不具有特异性，来自流行地区的患者通常通过活检进行诊断。

Blastomycosis

Skeletal localizations are observed in 14–60% of cases of diffuse blastomycosis. The spine is the most commonly involved skeletal site, followed by the skull, ribs, tibia and bones of the foot and wrist. The lower dorsal spine and lumbar segments are the most affected regions, similarly to tuberculosis. The anterior aspect of the vertebral body is usually involved in the early stages. Even non-adjacent vertebrae can be affected by infection along the anterior longitudinal ligament. This can cause gross deformities of the vertebral spine. Paravertebral abscesses or iliopsoas muscle can be documented.

芽生菌病

在14-60%的播散性芽生菌病例中观察到骨骼病灶。脊柱是最常见的骨骼部位,后面是头骨、肋骨、胫骨和脚和手腕的骨头。下胸段和腰段脊柱是受影响最严重的区域,类似于肺结核。椎体的前方通常早期受累。即使是非相邻的椎骨也通过前纵韧带下扩散引起感染。这可能导致脊椎严重畸形。可以发现椎旁脓肿或髂腰肌脓肿。

Parasitic spinal infections

Several parasites affecting the central nervous system can affect the spine. The most common of these diseases is cysticercosis. In endemic regions, schistosomiasis is a common cause of spinal involvement. Toxoplasmosis is a pathogen frequently found in immunodepressed patients. Echinococcosis and hydatidosis are also emerging parasitic diseases in some parts of the world. Although the definitive diagnosis of a spinal parasitosis is usually confirmed by histological biopsy examination, the clinical suspicion is generally based on a combination of epidemiological, clinical, serological, and neuroimaging features.

寄生虫性脊柱感染

一些影响中枢神经系统的寄生虫会影响脊柱。这些疾病最常见的是囊尾蚴。在流行地区,血吸虫病是脊柱受累的常见原因。弓形虫病是免疫抑制患者经常发现的一种病原体。包虫病在某些区域流行。虽然脊柱寄生虫病的确诊通常通过组织学活检得到证实,但临床怀疑通常是基于流行病学、临床、血清学和神经成像特征的结合。

往期回顾：

脊柱感染性疾病和炎症/退变性疾病的鉴别诊断：磁共振的临床价值（八）

脊柱感染性疾病和炎症/退变性疾病的鉴别诊断：磁共振的临床价值（七）

脊柱感染性疾病和炎症/退变性疾病的鉴别诊断：磁共振的临床价值（六）