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磁振造影在診斷化膿性脊椎炎的應用：病例報告
The Use of MRI in Diagnosis of Pyogenic Spondylitis: Cases Report
摘要
化膿性脊椎炎並不很常見，常發生在年紀較大的糖尿病患，男性多於女性，亦可發生在免疫力較差和濫用藥物者。最常見的致病菌為金黃色葡萄球菌，但其它罕見的致病菌如鏈球菌屬草綠色類、肺炎桿菌、Actinetobacter calcoaceticus亦偶而可見。 我們重新評估三個化膿性脊椎炎的病例；他們都是男性，年紀在40-70歲間。三個病患都接受了磁振造影檢查，他們的磁振造影的主要發現為：（一）、被侵犯椎體鄰近椎間盤的部份會被不正常的組織取代，（二）、椎間盤狹窄、明顯變形及訊號改變，（三）、不正常的椎旁軟組織，（四）、合併硬膜上腔膿瘍，（五）、打藥後，被侵犯的椎間盤顯影。磁振造影對診斷化膿性脊椎炎很有幫助，除了可以早期偵查出病灶外，更可提供磁振影像的特殊發現以確定診斷，顯影後的磁振造影影像更能幫助診斷。
並列摘要
Pyogenic spondylitis is uncommon. Elderly diabetic patients are most frequently affected. Persons with immunocompromise and drug abusers are also at risk. Staphylococcus aureus is the most common pyogenic organism. However Streptococcus Viridans, Klebsilla Pneumonia and Actinetobacter Calcoacetius are occasionally encountered. Three cases of pyogenic spondylitis were reviewed retrospectively. MRI was performed for these three cases at 1.5 T (Signa GE medial system). Gadolium-DTPA was administered intravenously followed by the fat-suppression technique to get enhanced scans. The chief MRI findings of our cases include :1) replacement of the normal marrow by abnormal tissue adjacent to the disc, in two involved vertebrae, 2) narrowing of the disc space, contour deformity, and signal change, 3) abnormal paraspinal soft tissue or subligamentous masses, 4) epidural abscess, 5) enhanced involved discs. MRI can offer characteristic findings of pyogenic spondylitis. Enhanced scans can be more helpful in establishing the diagnosis. Rare organisms such as Streptococcus Viridans, Klebsilla Pneumonia and Actinetobacter Calcoacetius are occasionally encountered. The final diagnosis should be based on findings revealed through biopsy & aspiration.
延伸閱讀
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