化脓性脊椎炎的MRI表现与分期(附50例报道)  

MR imaging manifestations and staging of pyogenic spondylitis(report of 50 cases)

作　　者：周守国[1] 王娟[1] 赵晓梅[1] 樊长姝[1] 

机构地区：[1]广州中医药大学附属佛山中医院MR室,广东528000

出　　处：《影像诊断与介入放射学》2011年第3期218-221,共4页Diagnostic Imaging & Interventional Radiology

摘　　要：目的总结化脓性脊椎炎的MRI表现并对其进行分期,提高MRI鉴别诊断水平。方法回顾性分析50例经手术病理或临床证实的化脓性脊椎炎的MRI表现,分别观察椎间盘、椎体及附件、椎旁软组织与椎管内软组织改变,分析病变蔓延方式。根据椎间盘MRI表现与椎体破坏程度,将其分为四期。结果 50例化脓性脊椎炎中,累及颈椎3例,胸椎5例,胸12/腰1椎体5例,腰椎31例,腰5/骶1椎体6例。7例椎间盘信号未见异常,43例椎间盘不同程度受累。MRI分期:Ⅰ期7例,Ⅱ期18例,Ⅲ期8例,Ⅳ期17例。42例椎体终板、终板下信号异常。46例椎旁软组织边界模糊不规则异常信号影,实性强化者26例,小脓肿14例,较大脓肿7例。椎管内硬膜囊外脓肿、肉芽肿形成28例。5例为经前后纵韧带下或椎旁软组织蔓延,31例相邻椎体直接通过椎间盘而蔓延。结论化脓性脊椎炎MRI表现具有一定的特征性,MRI对诊断与鉴别诊断具有很高的价值。Objective To investigate MRI features and staging of pyogenic spondylitis and to evaluate MRI value in the differential diagnosis of the disease. Methods The MRI findings of 50 cases pathologically or clinically proven with pyogenic spondylitis were retrospectively analyzed. The features ofintervertebral disc, centrum, appendix of vertebra, soft tissue of intraspinal and extra-vertebral canal were observed. All the cases were divided into 4 stages according to the findings of MRI and degree of destruction in centrum. Results The lesion originated from the cervical vertebra （3 cases）, thoracic vertebra （5 cases）, Th12/L1 （5 cases）, lumbar vertebra （31 cases） and LS/S 1 （6 cases）. The disc was damaged in 43 cases, while no abnormal findings of intervertebral dics showed in 7 cases. The MRI findings of 50 patients were divided into the first stage （7 cases）, second stage （18 cases）, third stage （8 cases） and fourth stage （17 cases）. There was abnormal signal in endplate in 42 cases. Abnormal signal of soft tissue was observed in 46 cases, including the parenchymal intensification （26 cases）, micmabscess（14 cases） and comparatively large abscess（7 cases）. Granulation tissue and abscess were formed in spinal canal in 28 cases. 5 cases and 31 cases spreaded by longitudinal ligaments and intervertebral disc respectively. Conclusion MRI examinations can provide characteristic features and helpful information for the clinical diagnosis and differential diagnosis of pyogenic spondylitis.

关 键 词：化脓性脊椎炎 分期 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R681.51[医药卫生—诊断学]