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椎间盘炎MRI诊断 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……IM @1989：椎间盘炎（Discitis） 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：软骨终板和纤维环弥散 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1/3－1/2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（10－12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（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=1.5～3:1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—MRIDepartment of Radiology, Medical School Hospital of Qingdao UniversityMRI检查方法方位矢状位横轴位冠状位序列Fat-Sat FSE T2WI, STIRSE T1WIFat-Sat PDWIFat-Sat SE T1WI +C(Gd-DTPA)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%出现时间：发病1－4周终板假性残留：化学位移伪影 Department of Radiology, Medical School Hospital of Qingdao UniversityDepartment 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 University1M LaterDepartment 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（2－4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, Medical School Hospital of Qingdao Un