术后椎间盘炎的MRI诊断(附15例报告)

MRI Diagnosis of Postoperative Intervertebral Discitis (A Report of 15 Cases)

目的 探讨MRI对术后椎间盘炎的诊断价值。资料与方法 15例经临床或病理证实的术后椎间盘炎MRI检查 ,其中 13例发生在腰椎 ,2例腰骶椎同时受累 ;均行矢状位及横断位SE序列T1WI、T2 WI扫描 ,部分病例作了冠状位扫描 ;5例行Gd DTPA增强扫描。结果 15例中 17个椎间盘炎 ,其中 13个椎间隙变窄 ,椎间盘呈不同程度破坏、碎裂 ;3个椎间隙变化不明显 ;1个椎间隙增宽 ,椎间盘肿胀增厚。T1WI 13个椎间盘呈长T1信号 ,4个呈等信号 ;T2 WI15个呈长T2 信号 ,2个呈短T2 信号 ;14个髓核内正常裂隙状短T2 信号消失。相邻椎体受累破坏程度不一 ,均未见塌陷 ,以长T1长T2 信号为主。有 8例椎旁软组织肿胀 ,其中 2例累及硬膜外间隙。 5例Gd DTPA增强扫描病变椎间盘及邻近椎体、椎旁软组织明显异常强化。结论 MRI对诊断术后椎间盘炎具有很高的敏感性及准确性 ,明显优于平片及CT。

Objective To evaluate MRI in the diagnosis of postoperative intervertebral discitis.Materials and Methods MRI was performed in 15 cases with pathologically or clinically proved postoperative discitis, of which the lesion developed at lumbar spine in 13, at both lumbar spine and sacrum in 2 cases. Both sagittal and axial SE T1WI and T 2WI scanning were carried out in all cases, with additional coronal scanning in some cases. Gd DTPA enhanced scanning was done in 5 cases.Results Of 17 intervertebral discitis in 15 cases, narrowed intervertebral space, destruction and rupture of the discs to varying degree were seen in 13, widened intervertebral space with thickened swollen disc in 1, and no obvious change of the intervertebral space in 3. On T 1WI, 13 discs showed long T 1 signal and 4 discs showed iso signal. On T 2WI, 15 discs displayed long T 2 signal and 2 discs displayed short T 2 signal. The normally seen crack shaped short T 2 signal in pulpiform nucleus disappeared in 14 discs. The adjacent vertebral bodies were involved and destroyed to varying degree without collapse and displayed mainly long T 1 and long T 2 signal. Tumefaction of paraspinal soft tissue was seen in 8 cases, of which extradural space was involved in 2. Obviously abnormal enhancement of the diseased discs, adjacent vertebral bodies and paraspinal soft tissue after Gd DTPA injection was found in 5 cases.Conclusion MRI carries high sensitivity and accuracy in the diagnosis of postoperative intervertebral discitis. It is definitely superior to plain film or CT scan.