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Descriptiveness ray method in the diagnosis of tuberculous spondylitis
Makhmudova Zulfiya Primkulova, Senior Researcher Republican Specialized Scientific Practical Medical Center Phthisiology and Pulmonology E-mail: evovision@bk.ru
Descriptiveness ray method in the diagnosis of tuberculous spondylitis
Abstract: The use of CT and MRI opened up new possibilities in the diagnosis of tuberculosis spondylitis; CT and MRI are highly effective in the detection of spinal cord compression in patients with tuberculosis spondylitis. The diagnostic efficacy of CT — 98.1 %, MRI — 100 %. MRI is more effective in determining the extent of compression (100 %) and is the only method of visualization of changes in the spinal cord.
Keywords: computed tomography magnetic resonance imaging tuberculosis spondylitis.
Osteoarticular tuberculosis is one of the leading TB problems. In the structure of the localization of osteoarticular tuberculosis of the spine is stable and ranked first is 70-75 %. Violation of the support function of the spine, the formation of abscesses, the incidence of neurological disorders ofvarying severity, diagnosis and adequate treatment delay cause the severity of disease and a high level of disability of patients from 40 to 50 [1].
The similarity of clinical and radiological picture with different etiology spondylitis causes diagnostic difficulties in verification of the diagnosis. In this regard, relevant is the early and timely diagnosis of tuberculosis spondylitis using modern radiation techniques [2; 3].
Implementation possibilities of modern surgery in tuberculous spondylitis is largely dependent on timely, accurate visualization of the pathological process and the correct assessment of the results of surgical interventions. So far evaluation of the effectiveness of surgical treatment of spinal tuberculosis was carried out by X-ray, which does not give a complete picture of bone regeneration and transplantation, does not detect the changes in the spinal cord and its membranes, which are the cause of spinal disorders after surgery. Implementation possibilities of modern surgery in tuberculosis spondylitis is largely dependent on timely, accurate visualization of the pathological process and the correct assessment of the results of surgical interventions. So far evaluation of the effectiveness of surgical treatment of spinal tuberculosis was carried out by X-ray, which does not give a complete picture of bone regeneration and transplantation, does not detect the changes in the spinal cord and its membranes, which are the cause of spinal disorders after surgery.
In the last decade, significantly increased the level of radiation diagnosis in identifying the causes of spinal disorders of various origins. The technique of contrasting the subarachnoid space of the positive water-soluble agents — Contrast myelography (KMG). The advent of magnetic resonance imaging (MRI), computed tomography (CT) has opened up new possibilities in the diagnosis of complicated and uncomplicated forms tuberculosis spondylitis.
In this regard, the aim of this study was: to study the role of radiation diagnosis in detecting tuberculosis spondylitis and causes of spinal disorders.
Materials and methods
We have analyzed the medical records of 140 patients with tuberculous spondylitis treated in osteo-articular branch of Republican Specialized Scientific Practical Medical Center Phthisiology and Pulmonology.
Among the studied patients with tuberculosis of bones and joints (TKSS) by age of the main indicators were persons from 18 to 55 years. Of these men have made — 80 (57.1 %) patients, women — 60 (42.9 %).
For the purpose of interpreting the clinical and radiological changes in the spine, taking into account the localization process,
all the patients were divided into the following groups: the thoracic spine tuberculosis — 31 (22.1 %), with the thoracolumbar spine tuberculosis — 25 (17.9 %) with lumbar spine tuberculosis — 48 (34.3 %) with sacral spine tuberculosis — 18 (12.9 %).
In terms of the distribution of vertebral lesion patients was as follows: the defeat of a specific process 2 vertebrae was detected in 30 (21.4 %) patients, lesions specific process 3 vertebrae — in 51 (36.4 %), defeated by 4 to 6 — 53 (37.9 %) and 6 (4.3 %) loss of more than 6 vertebrae. It should be noted that the prescription of a pathological process in the spinal column, it was 1 in 68 (48.6 %) patients, aged 2 — 36 (25.7 %), up to 3 years — 19 (13.6 %) and higher 3 years — in 17 (12.1 %) cases.
In 132 (94.3 %) patients underwent radical surgery, restorative nature. The diagnosis of "tuberculosis spondylitis" confirmed histo-logical and bacteriologic in 132 (94.3 %) patients; the remaining 8 (5.7 %) cases — clinical - X-ray laboratory confirmation.
In the preoperative period of observation in 125 (89.3 %) patients set paravertebral, presacral, epidural, psoas abscess and fistula, and often in large numbers. Bone grafting in the main process performed in all patients operated on. At the same time, 56 (42.4 %) patients used grafts taken from the rib (from 2 to 4 pieces) in 70 (53.0 %) used from the iliac crest, and in 6 (4.5 %) used in the fibula In 132 (94.3 %) patients underwent radical surgery, restorative nature. The diagnosis of "tuberculosis spondylitis" confirmed histologically and bacteriologically in 132 (94.3 %) patients; the remaining 8 (5.7 %) cases — clinical - X-ray laboratory confirmation.
The study ofthe characteristics ofpain symptoms in the patients examined, and their frequency are as follows: the most common and long-standing symptom was pain at rest in 75 (53.6 %) patients, with a load ofpain in 140 (100 %), limitation of motion in 72 (51.4 %) patients. Total pronounced pain syndrome was observed in 23 patients, pain in the affected spinal tuberculosis at 69, girdle pains on intercostal space in 27, radicular pain radiating to the lower extremities, 16 epigastric pain and right upper quadrant in 38 patients.
Among the new cases 40 (28.6 %) patients were sent to ftizio-orthopedic department of surgical departments general health, which were carried out in terms of different surgical procedures. clinical picture of erosion has led to the erroneous diagnosis and long-term treatment of these patients (1 to 5 years) about nontu-berculous etiology.
An analysis of your material showed that the percentage of erroneous interpretation of the results of radiation survey tuberculosis spondylitis in the early stages is still large, dominated by late diagnosis of tuberculosis spondylitis. In 96.0 % of cases, the process has been revealed during the height of spondylitis in 33.0 % on developed neurological disorders. The most common process involved 2-3-4-5-6 vertebra.
Section 5. Medical science
Infiltration in the spinal canal were detected in 45 (32.1 %) patients. Radiographs abscesses are well identified in the thoracic spine, where they are seen against the backdrop of the air of the lung tissue. Retroperitoneal abscesses were detected by indirect signs of expansion m.iliopsoas major circuits, when they reached a considerable size. It was impossible to see the abscess of the soft tissue of the back and small paravertebral abscesses in the lumbar spine.
The contours of abscesses and their relationship with the surrounding organs at radiographs and tomograms could not always identify. CT and MRI are equally well detected abscesses, their cameras, relations with the vertebrae and surrounding organs and tissues, especially after the internal contrast. At an early stage of formation of an abscess was observed infiltration of fat around the body of a vertebra. MRI advantage — the ability to study that reveals abscesses relations not only with the surrounding tissues,
and their connection with each other. Comprehensive assessment of bone structure changes detected on rentge-notomogramma and CT scan, and pathological changes in the MRI signal, gave an idea of the morphological changes in the spinal column and tuberculous spondylitis phase.
Conclusions
The use of CT and MRI opened up new possibilities in the diagnosis of tuberculosis spondylitis; CT and MRI are highly effective in the detection of spinal cord compression in patients with tuberculosis spondylitis. The diagnostic efficacy of CT — 98.1 %, MRI — 100 %. MRI is more effective in determining the extent of compression (100 %) and is the only method of visualization of changes in the spinal cord. The use of CT and MRI in the postoperative period allows to obtain objective criteria for evaluating the effectiveness of surgical treatment and to determine further treatment policy.
References:
1. Кульчавеня Е. В. Клинико-эпидемиологические особенности современного туберкулёзного спондилита//Туберкулез и болезни легких. - 2013. - № 1. - С. 41-45.
2. Советова Н. А. Туберкулезный спондилит у взрослых (клинико-лучевые проявления)//Туберкулез и болезни легких. - 2014. -№ 2. - С. 10-14.
3. Смердин С. В. Возможности лучевой диагностики туберкулезного спондилита//Туберкулез и болезни легких. - 2014. - № 7. -С. 65-70.
Khodjaeva Nazima Khayrullaevna, Navruzov Sarimbek Navruzovich, Kahhorov Jamal Nematovich, National Cancer Center of Uzbekistan, Ministry of Health of Uzbekistan E-mail: dr.bahodirova@bk.ru Kulabdullaev Gayrat Asatovich, Kim Andrey Alekseevich, Institute of Nuclear Physics, Uzbekistan Academy of Science
Preclinical studies of neutron capture therapy effectiveness in the treatment of malignant tumours, at the nuclear reactor HVR-SM INP AS of RUz
Abstract: Developed for treatment of radio resistant malignant tumors the Gadolinium neutron capture therapy (GdNCT) is based on the nuclear capture and reactions that occur when 155Gd and 157Gd, which are non-radioactive constituents of natural elemental gadolinium, are irradiated by thermal neutrons with low energy, In this article, results of scientific researches on development GdNCT in Uzbekistan are presented. The beam of epithermal neutrons with characteristics satisfying the all requirements of IAEA was received. As gadolinium delivery agent the well-known pharmacological preparation Magnevist was chosen. For absorbed dose calculation, the Magnevist pharmacokinetics was studied after intratumoral injection in mice and intramuscular injection in rats. Results of researches of influence epithermal neutrons beam on binding ability of transport proteins of human blood, on tumor cells C-180 at mice and on surgical material of human stomach adenocarcinoma are presented. Planned scientific researches with application of this beam in Uzbekistan are summarized.
Keywords: Neutron capture therapy, oncology, radiology, reactor, neutron.
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