椎间盘炎mri诊断..ppt

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（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 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 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 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 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