腰椎MRI检查中ModicⅠ型改变的鉴别诊断

Differential diagnosis of Modic typeⅠchanges in lumbar spine MRI

目的:总结ModicⅠ型改变的临床及MRI影像学特征,以提高对该病的鉴别诊断水平。方法:回顾性分析2018年10月至2019年3月行腰椎MRI检查患者的临床及MRI资料。选取经MRI确诊为ModicⅠ型改变的患者34例,经临床或病理证实易误诊为ModicⅠ型改变的患者40例(化脓性炎症7例、椎体结核7例、结缔组织病累及腰椎11例、椎体骨折7例、椎体转移瘤8例),对病变在终板、终板下、椎间盘及其周围的信号改变等进行分析。结果:ModicⅠ型改变常多发,多分布于腰4、5椎体上下缘,病变边界清楚,相应终板毛糙、变薄、波浪状改变,相邻椎间盘退变严重;化脓性炎症均为单发,椎间盘、终板破坏严重,终板下骨质破坏轻,多有周围软组织肿胀、脓肿形成;椎体结核单发多见,椎间盘存在,终板破坏、骨质破坏常见,有脓肿形成,周围软组织肿胀较轻;结缔组织病累及腰椎常多发,病变均位于椎体边缘,椎间盘形态、信号完整常见,终板无破坏常见,小关节、肌肉、韧带水肿常见,无骨质破坏、脓肿形成;椎体骨折单发、腰3以上居多,椎体上缘塌陷,骨折线显示清晰,终板断裂、错位,椎间盘信号异常、形态尚存在,周围肌肉、韧带水肿;椎体转移瘤可单发、多发,椎间盘完整,病灶处终板局部破坏,肌肉、韧带常有水肿。结论:ModicⅠ型改变具有典型的影像学特征,MRI对该病的鉴别诊断具有重要价值,但确诊还需要详细询问病史、结合临床表现与实验室检查。

Objective To summarize the MRI features of vertebral endplate lesion and improve its differential diagnosis. Methods A total of 74 patients with confirmed or suspected vertebral endplate lesion from October 2018 to March 2019 had their clinical and MRI data retrospectively analyzed, including 34 cases of endplate inflammation ModicⅠtype, 7 cases of purulent inflammation, 7 cases of vertebral tuberculosis, 11 cases of connective tissue disease, 7 cases of vertebral fracture and 8 cases of metastatic tumor. Main observations were made to analyze the signal changes in the lesions under the endplate, intervertebral disc and its surroundings. Results ModicⅠtype end plate inflammation often showed multiple vertebral involvement at upper and lower margins of the fourth and fifth vertebrae, which had clear boundaries, coarse and thinned endplate with wave-shaped changes as well as adjacent intervertebral disc degeneration;purulent inflammation often occurred singly, which had severely damaged intervertebral disc and endplate, slight bone destruction under the endplate as well as swelling and abscess of surrounding soft tissue;vertebral tuberculosis also occurred singly often, which had damaged endplate and bone as well as abscess and mild swelling of the surrounding soft tissue;connective tissue disease showed multi lumbar vertebra involvement at the edges which had usually complete morphology and signals of intervertebral disc, edemas of facet joint, muscle and ligament while non damage to the endplate nor bone deconstruction or abscess;vertebral fracture occurred singly, which was placed above the third lumbar vertebra and had collapsed upper margin of vertebra, clear fracture line, broken or misplaced endplate, intervertebral disc with abnormal signals and normal morphology as well as abscesses of the surrounding muscle and ligament;vertebral body metastatic tumor could be single or multiple, which had complete intervertebral disc, localized damage of endplate as well as edemas of muscle and ligament. Conclusion Modic typeⅠchanges has typical imaging features, and MRI is of great value for its differential diagnosis, although medical history, clinical symptoms and laboratory findings have to be combined for definite diagnosis.