椎间盘炎MRI诊断.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,椎间盘炎,MRI,诊断,Department of Radiology,Medical School Hospital of Qingdao University,1,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,2,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,3,椎间盘炎,病因与病理,椎间盘解剖,4,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,5,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、艾希氏大肠杆菌、嗜血菌、克雷白杆菌、肺炎双球菌、霉菌、,K,Kingae,菌等,混合感染,Department of Radiology,Medical School Hospital of Qingdao University,6,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,7,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,不规则侵蚀、破坏,Department of Radiology,Medical School Hospital of Qingdao University,8,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,9,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,10,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,11,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,STIR,SE T1WI,Fat-Sat PDWI,Fat-Sat SE T1WI+C(Gd-DTPA),Department of Radiology,Medical School Hospital of Qingdao University,12,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,13,14,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,15,16,17,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 University,18,19,Department of Radiology,Medical School Hospital of Qingdao University,20,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 University,21,1M Later,Department of Radiology,Medical School Hospital of Qingdao University,22,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 University,23,24,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,25,26,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,水肿：长,T1,长T2,信号,Department of Radiology,Medical School Hospital of Qingdao University,27,28,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,29,椎间骨软骨炎,Department of Radiology,Medical School Hospital of Qingdao University,30,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,31,椎间盘炎,鉴别诊断,Department of Radiology,Medical School Hospital of Qingdao University,32,椎间盘炎,鉴别诊断骨髓肿瘤,椎体骨质破坏区,信号：软组织信号,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,33,多发性骨髓瘤,Department of Radiology,Medical School Hospital of Qingdao University,34,肺癌骨转移,Department of Radiology,Medical School Hospital of Qingdao University,35,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,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,36,Department of Radiology,Medical School Hospital of Qingdao University,椎间盘退变,37,椎间盘炎,鉴别诊断,Department of Radiology,Medical School Hospital of Qingdao University,压缩性骨折,38,Department of Radiology,Medical School Hospital of Qingdao University,Thank You!,39,