椎间型感染性脊椎炎的CT及MRI表现

目的：总结椎间型感染性脊椎炎（IIS）的CT及MRI表现。资料与方法：回顾分析8例经病理或临床证实的IIS的CT及MRI表现,其中颈椎1例,胸椎3例,腰椎4例。6例行CT检查,4例行MR检查（有2例仅行MR检查）。结果：3例表现为椎间隙单侧椎体局限性病变（局限型）,5例病变累及椎间盘及其上下椎体（弥漫型）。局限型CT表现为椎体终端板及终端板下局限性破坏,早期边缘呈晕征（高密度）,并可逐渐扩大,治疗后逐渐减小形成硬化边;MRI显示病变为长T1、T2信号,与椎间盘界限清楚,注射Gd－DTPA后边缘明显强化。局限型一般不伴有周围软组织肿胀.弥漫型CT及MRI均表现为且相对较小,可与结核鉴别。结论：CT和MRI有利于IS的诊断和分型,便于疗效的监测,相比较而言,MRI具有更大的优势。

CT and MRI Manifestations of Intervertebral Infectious Spondylitis

Objective To summarize CT and MRI manifestations of intervertebral infectious spondylitis (IIS).Materials and Methods CT and MRI findings in 8 patients with pathologically or clinically proved IIS were retrospectively analyzed. The lesions were located in cervical spine (n=1), thoracic spine (n=3) or lumbar spine (n=4). CT scan was performed in 6 cases, of which additional MRI was done in 2. The remaining 2 cases underwent MRI only.Results Localized type (L type), when the lesion localized in vertebral endplate and sub endplate area, was seen in 3 cases, while diffused type (D type), when the lesion involved disc and adjacent vertebral bodies, was seen in 5 cases. For L type, the lesions displayed localized destruction of the vertebral endplate and sub endplate on CT scans. At its early stage, high density "halo sign" at the lesion's margin could be seen, which enlarged gradually and became smaller, sclerosis after therapy. On MRI, most lesions showed long T 1 and long T 2 signals with a clear demarcation with the disc, after Gd DTPA injection, the lesion's margin displayed marked enhancement. Usually, tumefaction of the surrounding soft tissue was not seen. In D type, destruction of the disc and the adjacent vertebral bodies, as well as narrowed intervertebral space, could be seen on both CT and MRI. The lesion seemed to be a little larger on MRI than that on CT. Tumefaction of the surrounding soft tissue was often accompanied, and abscess formation was fewer and smaller than that in tuberculosis.Conclusion CT and MRI is helpful in diagnosing and typing IIS, and in monitoring the therapeutic response. Compared with CT, MRI is of more value.