摘要目的 探讨椎间型化脓性脊椎炎的MRI表现特征.方法 对12例经手术证实、6例经临床确诊的椎间型化脓性脊椎炎MRI表现进行回顾性分析.18例患者均常规平扫,其中11例同时进行了增强扫描.结果 18例患者中16例单发、2例多发.MRI表现:(1)椎间盘改变:17例T2WI号增高,呈核裂消失征,15例椎间盘积液,4例椎间盘穿孔,7例椎间隙狭窄.(2)相邻终板及椎体改变:18例均有终板下骨质破坏及椎体非破坏区骨髓水肿,17例终板破坏,16例示终板掩盖征.(3)椎旁软组织改变:18例均有椎旁软组织肿胀,4例形成厚壁小脓肿.(4)椎管与附件改变:12例椎管受累,表现为硬脊膜囊前间隙增宽,信号混杂,5例形成脓肿,未见附件受累.(5)增强扫描:11例中破坏区旱条块状强化4例,结节样强化和环状强化各2例,不强化3例;椎体非破坏区及椎周软组织不均匀强化;6例硬脊膜囊旱线样强化,10例硬脊膜囊前间隙呈斑片状强化.结论 椎间型化脓性脊椎炎MRI表现具有特征性,密切结合临床和MRI表现是诊断的关键.

abstractsObjective To explore MRI findings of intervertebral suppurative spondylitis. Methods MRI findings of intervertebral suppurative spondylitis in 12 cases proved by surgery and 6 cases defined by clinical features were retrospectively analyzed. The MRI protocol included un-enhanced conventional scan in 18 cases and contrast-enhanced scan in 11 cases. Results Of the 18 cases, single focus was found in 16 cases, and multiple loci were seen in 2 cases. MRI findings included (1) Disappearance sign of nuclear crevice in 17 cases, accumulated fluid sign of intervertebral disc in 15 cases, intervertebral disc perforation in 4 cases, and intervertebral space narrowing in 7 cases. (2) Bone destruction under end plate and marrow oedema were shown in 18 cases, 17 cases had end plate destruction, 16 cases had covered sign of end plate.(3) Paraspinal soft tissue swelling was shown in 18 cases, in which thick wall microabscess was formed in 4 cases. (4) Vertebral canal was involved in 12 cases, vertebral canal abscess was formed in 5 cases.(5) Lump enhancement was demonstrated in 4 cases, nodular enhancement in 2, and ring-like enhancement in 2, respectively. No enhancement was seen in 3 cases. Dural sac linear enhancement was shown in 6 cases, and patchy enhancement in the anterior dural sac was shown in 10 cases. Conclusion Intervertebral suppurative spondytitis had characteristic MRI findings, and the key to correct diagnosis was to combine MRI finding with clinical characteristics.