关键词: 磁共振成像, 布鲁氏菌性脊柱炎, 脊柱结核, 鉴别诊断

Abstract: Objective To investigate the value of magnetic resonance imaging (MRI) in the differential diagnosis of brucellosis spondylitis and spinal tuberculosis,and to provide reference for the differential diagnosis of brucellosis spondylitis and spinal tuberculosis. Method To select the records of 87 patients with spinal tuberculosis in the Guangzhou Chest Hospital as spinal tuberculosis group, 23 patients with brucellosis spondylitis as spondylitis group （Guangzhou Chest Hospital 5 cases, Huiya Hospital of The First Affiliated Hospital, Sun Yat-sen University 18 cases）from January 2019 to December 2021, all patients were performed MRI, according to the comparison of two groups of parts image information, the number of vertebral involvement, the affected vertebral signal morphological characteristics, destruction of vertebral bodies and intervertebral disc narrow and abscess. Result There was no significant difference in the incidence site and number of vertebral body involvement between the two groups (P>0.05). There was a significant difference in the signal morphology characteristics of the affected vertebral bodies between the two groups (P<0.05),among which the proportion of diffuse signals in the spondylitis group (50.00%) was lower than that in the spinal tuberculosis group (88.89%), the proportion of focal signals (30.43%) was higher than that in the spinal tuberculosis group (11.11%), and the proportion of fan-shaped signals (23.08%) was higher than that in the spinal tuberculosis group (0).There was a significant difference between the two groups in terms of vertebral body destruction and intervertebral disc stenosis (P<0.05). Among them, the proportion of vertebral collapse (0) in the spondylitis group was lower than that in the spinal tuberculosis group (43.52%), the proportion of kyphosis deformity (3.85%) was lower than that in the spinal tuberculosis group (24.07%), and the proportion of bone destruction around the intervertebral disc (46.15%) was higher than that in the spinal tuberculosis group (10.19%). Comparison of abscess signals between two groups: the proportion of paravertebral abscesses in the spinal tuberculosis group (54.02%) was higher than that in the spinal tuberculosis group (30.43%), the proportion of abnormal signals in the paravertebral soft tissue in the spinal tuberculosis group (91.95%) was higher than that in the spinal tuberculosis group (52.17%), and the proportion of abscesses under the ligament in the spinal tuberculosis group ≥ 3 vertebral levels (6.67%) was lower than that in the spinal tuberculosis group (57.75%), with statistically significant differences (P<0.05); There was no significant difference in the proportion of epidural abscess (47.83%), epidural abscess with neurological symptoms (34.78%), and abscess under anterior longitudinal ligament (65.22%) between the spondylitis group and the spinal tuberculosis group (P>0.05). Conclusion The degree of bone destruction, vertebral signal shape, paravertebral abscess, paravertebral soft tissue abnormal signal, and abscess diffusion in MRI examination of patients with Brucella spondylitis and spinal tuberculosis are significantly different, which can provide an important reference for clinicians to identify the two diseases.

Key words: Magnetic resonance imaging, Brucellosis spondylitis, Spinal tuberculosis, Differential diagnosis