腰椎间盘纤维环撕裂的MRI表现及临床意义

The utility of MRI in Evaluation of Annular Fissure of Lumbar Intervertebral Disc with Correlated Clinical Significance

目的探讨腰椎间盘纤维环撕裂的MRI表现及临床意义。方法收集因腰痛住院并进行腰椎MR检查呈阳性患者33例。其中慢性腰痛者（半年以上）24例，有急性外伤史6例，临床表现近1个月持续性腰痛3例。MRI检查主要以T2WI矢状位及轴位扫描，部分患者加扫FS-T2WI及CE-T1WI。结果3例慢性腰痛及3例急性腰扭伤患者表现为弧形撕裂，MRI轴位T2WI上显示于椎间盘后缘弧形高信号，矢状位T2WI椎间盘后缘硬脊膜外点状或小结节状高信号。1例慢性腰痛及3例急性外伤患者表现为横形撕裂，MRI轴位T2WI上椎间盘后缘偏外层横形条状高信号，矢状位于骨突附着处小条状或点状长T2信号。20例慢性腰痛患者表现为放射状撕裂，MRJ轴位T2WI上显示椎间盘中心向纤维环外层方向延伸的片状或类三角形高信号，矢状位表现为水平或向头足走行的长T2信号线条。3例近1个月腰痛患者表现为椎间盘后部的高信号带（high-intensityzone，HIZ），MR轴位T2WI上表现纤维环内层位置条形高信号。结论MRI检查能较满意显示腰椎间盘纤维环的撕裂，为临床对腰痛患者的病因诊断提供依据，从而指导临床治疗。

Objective To investigate MRI expression of annular fissure of the lumbar intervertebral disc and its correlated clinical significance. Methods 33 inpatients with lower back pain were included in this study, and all the patients＇ MRI showed abnormalities of annulus fibrosus. 24 patients of the cohort had chronic lower back pain （at least 6 months）, 6 patients had acute trauma, 3 patients complained lower back pain in one month. All the patients underwent axial and sagittal T2WI scan, FS-T2WI and CE-TlWI were also performed in some of the patients. Results Arc-shaped annular fissure was found in 3 patients with chronic lower back pain and 3 patients with acute lower back sprain, respectively, which represented as arc-shaped hyperintensities at posterior edge of lumbar intervetebral disc on MR images （axial） and spot or patchy hyperintensities between posterior of lumbar intervertebral disc and dural sac on sagittal images. Horizontal annular fissure was detected in 1 patient with chronic lower back pain and 3 patients with acute trauma, represented as horizontal linear hyperintensities on axial images and spot or linear T2W hyperintensities at attachment of the posterior of lumbar vertebral body on sagittal images. 20 patients with chronic lower back pain had radial annular fissure which presented as patchy hyperintensities extending from the center to out margins of intervertebral disc on axial images and horizontal. or vertical linear T2W hyperintensities on sagittal. High-intensity zone （HIZ） was found in 3 patients who complained lower back pain in 1 month, presented as linear hyperintensities in inner layer of annular fibrosis on axial. Conclusion Lumbar spine MRI is potential in evaluation annular fissure. Therefore, it can provide bases for clinical etiologic diagnosis and guide clinical treatment.