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1、椎间盘炎MRI诊断,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎概念,概念：椎间盘、终板和邻近椎体感染 椎间型感染性脊椎炎 椎间隙感染 化脓性椎间盘炎 脊椎-椎间盘炎 ,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎病因与病理,结构 纤维环 髓核 软骨终板 营养 婴幼儿 血供丰富 来源：椎体骨化中心，前、后纵韧带血管 13岁 无血供（纤维环周围结缔组织血管和淋巴管） 营养来源：软骨终板和
2、纤维环弥散,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎病因与病理,椎间盘解剖,椎间盘炎病因与病理,发病率：约占骨髓炎2% 易感因素 机遇性感染 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,椎间盘炎病因与病理,致病菌 革兰氏阳性菌：葡萄球菌（48.4）、链球菌、淋病双球菌、肠球菌等 革兰氏阴性菌：假单胞菌、布氏杆菌、沙门氏菌、艾希氏大肠杆
3、菌、嗜血菌、克雷白杆菌、肺炎双球菌、霉菌、KKingae菌等 混合感染,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎病因与病理,感染途径 血行性 医源性操作(如手术、介入等) 椎体骨髓炎 腹腔感染 泌尿系统感染 腹膜后感染,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎病理,纤维环、髓核 早期：水肿、渗出 进展期：液化坏死、椎间盘脓肿 后期：椎间盘退变、瘢痕形成、“真空征” 终板 不规则
4、侵蚀、破坏,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎病理,邻近椎体 骨髓内充血、渗出：骨质破坏 骨髓血管血栓形成：梗死 皮质中断 上或下1/31/2或全椎体破坏 椎体塌陷 椎体积气 愈合期：骨髓内脂肪沉积及骨硬化（1012周）,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎病理,硬脊膜外和/或椎旁软组织 脓肿 蜂窝组织炎 马尾和脊髓 压迫 功能损害：炎症介质毒性、血管血栓 脊髓水肿（
5、组织结构无破坏）,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎临床,年龄：7个月-83岁，青壮年多见 发病率：男：女=1.53:1 症状：疼痛、运动后加剧，持续性发烧 实验室 白细胞、血沉、C反应蛋白（） 部位 腰椎（52）胸椎（26）颈椎（22）,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎MRI,MRI检查方法 方位 矢状位 横轴位 冠状位 序列 Fat-Sat FSE T2WI,
6、 STIR SE T1WI Fat-Sat PDWI Fat-Sat SE T1WI +C(Gd-DTPA),Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎MRI,髓核改变 正常椎间盘 髓核显示率：94 T2WI：髓核裂隙征（ intranuclear cleft sign） 椎间盘炎 髓核裂隙征：阳性 诊断敏感性：83.3%,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎MRI,纤维环改
7、变 信号 早期：长/等T1信号，长T2高信号，信号均匀 慢性期：长T1长T2信号，信号不均匀 脓肿：长T1长T2液性信号 诊断敏感性 T1WI低信号：29.5% T2WI高信号或液性信号：93.2% 形态 不规则 突入邻近椎体上、下缘破坏区 增强扫描 位置：纤维环中央或上、下缘 形态：弥漫性或间断性、带状或斑片状强化 诊断敏感性：95.4%,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎MRI,终板改变 形态：不连续破坏 信号：长T1长T2信号 增强扫描：破坏区明显强化 诊断敏感性：84.1
8、% 出现时间：发病14周 终板假性残留：化学位移伪影,Department of Radiology, Medical School Hospital of Qingdao University,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎MRI,邻近椎体改变 部位：邻近两侧椎体，少数单侧 位置：椎体上或下1/3部，少数全椎体 表现 早期：骨髓水肿，长T1长T2信号 骨质破坏：长T1长T2信号 压缩骨折 痊愈期：椎体边缘脂肪沉积或骨硬化 增强扫描：不均匀性强化，强化时间略迟于椎间盘 出现时
9、间：终板破坏之后，少数终板完整 诊断敏感性：96；准确性：94；特异性：92,Department of Radiology, Medical School Hospital of Qingdao University,1M Later,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎MRI,椎间隙改变 早期：椎间隙无变窄 进展期（24周后） 变窄 1/2椎间隙 特异性 诊断敏感性：52.3% 椎间隙增宽：椎间盘脓肿、邻近椎体压缩,Department of Radiology, Medica
10、l School Hospital of Qingdao University,椎间盘炎MRI,椎旁软组织改变 蜂窝组织炎/脓肿：发生率90，特异性 蜂窝组织炎：长T1长T2信号，均匀或不均匀性强化 脓肿 见于急性期 长T1长T2信号 增强扫描：环样不均匀强化 诊断敏感性：97.7%,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎MRI,硬脊膜外间隙改变 部位：硬脊膜前方间隙，少数后方或环绕 范围：4个椎体，突向椎间孔 增强扫描：硬脊膜受累呈细线状强化 硬脊膜及脊髓：受压 脊髓改变 受压变形
11、 水肿：长T1长T2信号,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎鉴别诊断,椎间骨软骨炎 发病年龄早 椎间盘高度减低 邻近终板纤维环条带状强化 椎间盘“真空征” 椎体骨髓水肿：条带状或半球形，1/2椎体 对侧终板：无受累 骨质破坏：无 椎旁或硬脊膜外间隙软组织肿块：无,Department of Radiology, Medical School Hospital of Qingdao University,椎间骨软骨炎,Department of Radiology, Medical
12、 School Hospital of Qingdao University,椎间盘炎鉴别诊断,脊椎结核 临床症状和体征：不明显 病变分布：可呈跳跃性 椎旁炎性肿块：大 硬脊膜外/韧带下：侵犯 信号：不均匀长T1长T2信号 寒性脓肿：环状强化,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎鉴别诊断,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎鉴别诊断,骨髓肿瘤 椎体骨质破坏区 信号：软组
13、织信号 部位：椎体及附件 增强：均匀或不均匀强化 压缩性骨折 椎间盘信号、高度：无异常,Department of Radiology, Medical School Hospital of Qingdao University,多发性骨髓瘤,Department of Radiology, Medical School Hospital of Qingdao University,肺癌骨转移,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘炎鉴别诊断,椎间盘退行性变 椎体边缘部及终板骨质增生
14、长T1短T2信号 椎间盘真空征 椎间隙变窄 无椎旁及硬膜外炎性肿块 实验室检查：无异常,Department of Radiology, Medical School Hospital of Qingdao University,Department of Radiology, Medical School Hospital of Qingdao University,椎间盘退变,椎间盘炎鉴别诊断,Department of Radiology, Medical School Hospital of Qingdao University,压缩性骨折,Department of Radiology, Medical School Hospital of Qingdao University,Thank You !,
