CT EVALUATION OF SPINAL TUBERCULOSIS

電腦斷層攝影對脊椎結核的評估

陳志程(Jyh Ching Chen) ； 鄧木火(Michael Mu Huo Teng) ； 張政彥(Cheng-Yen Chang) ； 郭萬祐(Wan-Yuo Guo) ； 張遵(Tauen Chang)

《中華放射線醫學雜誌》 14卷2期 (1989/06) Pp. 121-126

摘要

In order to illustrate the importance of a good modality-CT scan-in evaluating the characteristics of spinal tuberculosis (TB) and its correlation with plain radiogram, seventeen cases of spinal tuberculosis in recent 5 years of V.G.H. were reviewed. Spinal tuberculosis presents as an osteolytic lesion of vertebrae causing loss of the height of the vertebral bodies and narrowing of the disc space. It is often associated with paravertebral abscess, with or without calcification. In a CT scan, abscess will present as a low density mass with ring-like or marginal enhancement. The calcification of the abscess will be in ring-like or punctate arrangement if present. The involved discs often have a low density part representing abscess. Spinal tuberculosis is sometimes associated with active pulmonary tuberculosis or with extensive expulmonary involvement. Involvement of two contiguous adjacent vertebral bodies are most frequently encountered. Most patients affected in this study are between their 4 th and 5 th decades. Most spinal TBs involved the thoracic-lumbar region. CT scan can provide good advantages in evaluating spinal tuberculosis. It detects the disease precisely and makes the differentiation between metastatic lesion or pyogenic spondylitis more easily.

關鍵字

computer tomography ； spinal tuberculosis ； metastatic lesion ； pyogenic spondylitis

並列摘要

電腦斷層攝影對於脊椎結核的特性的評估是一項重要的工具。爲了闡述脊椎結核在電腦斷層攝影的特性以及它在CT scan和一般X光片上表現的相關性，我們覆閱了榮民總醫院近五年來十七個經證實爲脊椎結核的病例。脊椎結核通常呈現爲蝕骨的病灶（osleolytic lesion），致使椎體的高度消失，並使椎狹窄（disc space narrowing）。此病常合併椎體旁膿瘍，膿瘍可能有或沒鈣化，而且在CT scan表現爲低密度的腫塊，打藥以後會有圈樣的或邊緣樣的密度增強（ring-like or marginal enhancement）。膿瘍的鈣化可呈圈樣的或點狀的排列。被膿瘍侵犯的椎間盤常會表現低密度區域（low density area）。脊椎結核可合併肺結核或脊椎其它部位廣泛性的侵犯。鄰近兩個椎體同時被侵犯爲最常發現，大多數的病患的年紀是在四十和五十歲之間，胸腰椎處是最好發部位。電腦斷層攝影檢視脊椎結核有很多優點，它可詳細地偵測病灶，有助於對轉移（metastasis）或化膿性脊椎炎（pyogenic spondylitis）的鑑別診斷。