椎間盤(pán)炎mri診斷

1、椎間盤(pán)炎MRI診斷,青島大學(xué)醫(yī)學(xué)院附屬醫(yī)院放射科徐文堅(jiān),Department of Radiology, Medical School Hospital of Qingdao University,椎間盤(pán)炎—概念,概念：椎間盤(pán)、終板和鄰近椎體感染椎間型感染性脊椎炎椎間隙感染化膿性椎間盤(pán)炎脊椎-椎間盤(pán)炎……IM @1989：椎間盤(pán)炎（Discitis）,Department of Radiology, Medical Sch

2、ool Hospital of Qingdao University,椎間盤(pán)炎—病因與病理,結(jié)構(gòu)纖維環(huán)髓核軟骨終板營(yíng)養(yǎng)嬰幼兒血供豐富來(lái)源：椎體骨化中心，前、后縱韌帶血管> 13歲無(wú)血供（纖維環(huán)周?chē)Y(jié)締組織血管和淋巴管）營(yíng)養(yǎng)來(lái)源：軟骨終板和纖維環(huán)彌散,Department of Radiology, Medical School Hospital of Qingdao University,椎間盤(pán)炎—病因與病理,

3、椎間盤(pán)解剖,椎間盤(pán)炎—病因與病理,發(fā)病率：約占骨髓炎2%易感因素機(jī)遇性感染免疫缺陷糖尿病全身性感染透析器官移植嗜可卡因,Department of Radiology, Medical School Hospital of Qingdao University,椎間盤(pán)炎—病因與病理,致病菌革蘭氏陽(yáng)性菌：葡萄球菌（48.4％）、鏈球菌、淋病雙球菌、腸球菌等革蘭氏陰性菌：假單胞菌、布氏桿菌、沙門(mén)氏菌、艾希氏大腸桿菌、嗜血

4、菌、克雷白桿菌、肺炎雙球菌、霉菌、K－Kingae菌等混合感染,Department of Radiology, Medical School Hospital of Qingdao University,椎間盤(pán)炎—病因與病理,感染途徑血行性醫(yī)源性操作(如手術(shù)、介入等)椎體骨髓炎腹腔感染泌尿系統(tǒng)感染腹膜后感染,Department of Radiology, Medical School Hospital of Qingd

5、ao University,椎間盤(pán)炎—病理,纖維環(huán)、髓核早期：水腫、滲出進(jìn)展期：液化壞死、椎間盤(pán)膿腫后期：椎間盤(pán)退變、瘢痕形成、“真空征” 終板不規(guī)則侵蝕、破壞,Department of Radiology, Medical School Hospital of Qingdao University,椎間盤(pán)炎—病理,鄰近椎體骨髓內(nèi)充血、滲出：骨質(zhì)破壞骨髓血管血栓形成：梗死皮質(zhì)中斷上或下1/3－1/2或全椎體破壞椎體

6、塌陷椎體積氣愈合期：骨髓內(nèi)脂肪沉積及骨硬化（10－12周）,Department of Radiology, Medical School Hospital of Qingdao University,椎間盤(pán)炎—病理,硬脊膜外和/或椎旁軟組織膿腫蜂窩組織炎馬尾和脊髓壓迫功能損害：炎癥介質(zhì)毒性、血管血栓脊髓水腫（組織結(jié)構(gòu)無(wú)破壞）,Department of Radiology, Medical School Hospita

7、l of Qingdao University,椎間盤(pán)炎—臨床,年齡：7個(gè)月-83歲，青壯年多見(jiàn)發(fā)病率：男：女=1.5～3:1癥狀：疼痛、運(yùn)動(dòng)后加劇，持續(xù)性發(fā)燒 實(shí)驗(yàn)室白細(xì)胞↑、血沉↑、C－反應(yīng)蛋白（＋）部位腰椎（52％）>胸椎（26％）>頸椎（22％）,Department of Radiology, Medical School Hospital of Qingdao University,椎間盤(pán)炎—MRI,

8、MRI檢查方法方位矢狀位橫軸位冠狀位序列Fat-Sat FSE T2WI, STIRSE T1WIFat-Sat PDWIFat-Sat SE T1WI +C(Gd-DTPA),Department of Radiology, Medical School Hospital of Qingdao University,椎間盤(pán)炎—MRI,髓核改變正常椎間盤(pán)髓核顯示率：94％T2WI：髓核裂隙征（ intranucl

9、ear cleft sign）椎間盤(pán)炎髓核裂隙征：陽(yáng)性診斷敏感性：83.3%,Department of Radiology, Medical School Hospital of Qingdao University,,椎間盤(pán)炎—MRI,纖維環(huán)改變信號(hào)早期：長(zhǎng)/等T1信號(hào)，長(zhǎng)T2高信號(hào)，信號(hào)均勻慢性期：長(zhǎng)T1長(zhǎng)T2信號(hào)，信號(hào)不均勻膿腫：長(zhǎng)T1長(zhǎng)T2液性信號(hào)診斷敏感性T1WI低信號(hào)：29.5%T2WI高信號(hào)或液性信號(hào)

10、：93.2%形態(tài)不規(guī)則突入鄰近椎體上、下緣破壞區(qū)增強(qiáng)掃描位置：纖維環(huán)中央或上、下緣形態(tài)：彌漫性或間斷性、帶狀或斑片狀強(qiáng)化診斷敏感性：95.4%,Department of Radiology, Medical School Hospital of Qingdao University,,,椎間盤(pán)炎—MRI,終板改變形態(tài)：不連續(xù)破壞信號(hào)：長(zhǎng)T1長(zhǎng)T2信號(hào)增強(qiáng)掃描：破壞區(qū)明顯強(qiáng)化診斷敏感性：84.1%出現(xiàn)時(shí)間：發(fā)病1

11、－4周終板假性殘留：化學(xué)位移偽影,Department of Radiology, Medical School Hospital of Qingdao University,,,Department of Radiology, Medical School Hospital of Qingdao University,椎間盤(pán)炎—MRI,鄰近椎體改變部位：鄰近兩側(cè)椎體，少數(shù)單側(cè)位置：椎體上或下1/3部，少數(shù)全椎體表現(xiàn)早期：骨髓

12、水腫，長(zhǎng)T1長(zhǎng)T2信號(hào)骨質(zhì)破壞：長(zhǎng)T1長(zhǎng)T2信號(hào)壓縮骨折痊愈期：椎體邊緣脂肪沉積或骨硬化增強(qiáng)掃描：不均勻性強(qiáng)化，強(qiáng)化時(shí)間略遲于椎間盤(pán)出現(xiàn)時(shí)間：終板破壞之后，少數(shù)終板完整診斷敏感性：96％；準(zhǔn)確性：94％；特異性：92％,Department of Radiology, Medical School Hospital of Qingdao University,,1M Later,Department of Radiology

13、, Medical School Hospital of Qingdao University,椎間盤(pán)炎—MRI,椎間隙改變?cè)缙冢鹤甸g隙無(wú)變窄進(jìn)展期（2－4周后）變窄<1/2椎間隙特異性診斷敏感性：52.3%椎間隙增寬：椎間盤(pán)膿腫、鄰近椎體壓縮,Department of Radiology, Medical School Hospital of Qingdao University,,椎間盤(pán)炎—MRI,椎旁軟組織改

14、變蜂窩組織炎/膿腫：發(fā)生率90％，特異性蜂窩組織炎：長(zhǎng)T1長(zhǎng)T2信號(hào)，均勻或不均勻性強(qiáng)化膿腫見(jiàn)于急性期長(zhǎng)T1長(zhǎng)T2信號(hào)增強(qiáng)掃描：環(huán)樣不均勻強(qiáng)化診斷敏感性：97.7%,Department of Radiology, Medical School Hospital of Qingdao University,,椎間盤(pán)炎—MRI,硬脊膜外間隙改變部位：硬脊膜前方間隙，少數(shù)后方或環(huán)繞范圍：<4個(gè)椎體，突向椎間孔增強(qiáng)掃

15、描：硬脊膜受累呈細(xì)線(xiàn)狀強(qiáng)化硬脊膜及脊髓：受壓脊髓改變受壓變形水腫：長(zhǎng)T1長(zhǎng)T2信號(hào),Department of Radiology, Medical School Hospital of Qingdao University,,椎間盤(pán)炎—鑒別診斷,椎間骨軟骨炎發(fā)病年齡早 椎間盤(pán)高度減低 鄰近終板纖維環(huán)條帶狀強(qiáng)化 椎間盤(pán)“真空征”椎體骨髓水腫：條帶狀或半球形，<1/2椎體對(duì)側(cè)終板：無(wú)受累骨質(zhì)破壞：無(wú)椎旁或硬脊

16、膜外間隙軟組織腫塊：無(wú),Department of Radiology, Medical School Hospital of Qingdao University,椎間骨軟骨炎,Department of Radiology, Medical School Hospital of Qingdao University,椎間盤(pán)炎—鑒別診斷,脊椎結(jié)核臨床癥狀和體征：不明顯病變分布：可呈跳躍性椎旁炎性腫塊：大硬脊膜外/韌帶下：侵犯

17、信號(hào)：不均勻長(zhǎng)T1長(zhǎng)T2信號(hào)寒性膿腫：環(huán)狀強(qiáng)化,Department of Radiology, Medical School Hospital of Qingdao University,椎間盤(pán)炎—鑒別診斷,Department of Radiology, Medical School Hospital of Qingdao University,多發(fā)性骨髓瘤,Department of Radiology, Medical Sch

18、ool Hospital of Qingdao University,肺癌骨轉(zhuǎn)移,Department of Radiology, Medical School Hospital of Qingdao University,椎間盤(pán)炎—鑒別診斷,椎間盤(pán)退行性變椎體邊緣部及終板骨質(zhì)增生長(zhǎng)T1短T2信號(hào)椎間盤(pán)真空征椎間隙變窄無(wú)椎旁及硬膜外炎性腫塊實(shí)驗(yàn)室檢查：無(wú)異常,Department of Radiology, Medical

19、School Hospital of Qingdao University,,Department of Radiology, Medical School Hospital of Qingdao University,椎間盤(pán)退變,椎間盤(pán)炎—鑒別診斷,Department of Radiology, Medical School Hospital of Qingdao University,壓縮性骨折,,Department of Ra