腰椎间盘炎MRI诊断及鉴别诊断——附5例报告

MR imaging in the diagnosis and identification of discitis (report of 5 cases)

目的探讨腰椎间盘炎的MRI表现并与腰椎结核及腰间盘退行性变引起的椎间隙变窄进行鉴别。方法5例为手术后及间盘穿刺术后、白血病等临床证实的间盘炎症,21例腰椎结核及腰间盘退行性变,对其MRI表现进行观察分析。结果腰椎间盘炎症MRI表现为:(1)椎间隙变窄,T2像呈高信号或低信号,T1呈低或等信号,髓核内裂隙消失。(2)相邻椎体皮质终板模糊或终板及终板下骨质破坏,上下椎体对称性信号异常。(3)部分病例见相邻椎体的临近部分呈长T1长T2信号。(4)椎旁软组织肿胀,脓肿象树皮一样围绕椎体。(5)增强间盘及临近椎体信号增强。10例腰椎结核及11例间盘退变也各有特点。结论腰椎间盘炎多由术后或穿刺或血行感染,MRI有其特点,仔细观察椎体终板及间盘及椎旁肿胀对诊断及鉴别诊断非常有益。

Objective To discuss MRI findings of discitis and identification of the disk space narrowd what are from lumber vertebrae tuberculosis and disc degeneration. Methods MRI was performed in 5case with postoperative and leukemia clinically proved intertebral discitis,15 case lumber vertebrae tuberculosis and disc denaturalization degeneration,to analyze the finding of MRI. Results MRI findings of discitis ： （1）narrowde intervertebral space ,On T1WI,sbowed long signal or isosignal,OnT2WI, showed long signal or short signal,pulpiform nucleus disappeared.（2）the adjacent vertebral bodies were involved symmetric.（3）the adjacent vertebral bodies in the part of cases were long T1WLlong T2WL（4）tumefaction of paraspinal soft tissue that rounned vertebral bodies like the cortex.（5）the adjacent vertebral bodies and parasoinal soft tissue after Gd-DTPA injection was found. Conclusion The intertebral discitis was from postoperativeor puncturing or hematogenous infection,the signals of MRI is especially, to observe vertebrae end-plate disk and paraspinal abscess carefully is significative to the diagnosis and identify of intervertebral discitis.