椎间盘炎与脊椎结核的MRI鉴别诊断

目的:探讨椎间盘炎与脊柱结核在MRI上的不同点,从而达到鉴别的目的。方法:20例为经手术后或椎间盘穿刺术后临床证实的椎间盘炎,20例为临床证实的脊柱结核。结果:椎间盘炎与脊柱结核在MRI上的不同点表现在:①临床表现上:椎间盘炎疼痛症状明显,而椎体结核早期可无任何临床症状;②椎间盘改变上:早期椎间盘炎以T2WI加权像髓核内低信号裂隙征消失为明显,椎间盘变狭为后期表现,而椎体结核中后期椎间盘才会有改变;③相邻椎体骨质改变上:椎间盘炎表现为相邻的上、下两个椎体的部分或全部对称性炎性改变,少有椎体骨折,而椎体结核椎体骨质多呈虫蚀样破坏,常侵蚀多个椎体,常合并病理性骨折;④椎旁软组织改变上:椎体结核远比椎间盘炎明显,椎体结核常侵犯到腰大肌、椎管内硬膜外间隙及一侧椎间孔,常使椎管狭窄,而椎间盘炎仅表现为椎间盘旁软组织的轻度肿胀。结论:椎间盘炎与脊柱结核各有其特点,仔细观察椎间盘、椎体以及椎旁软组织上的改变,结合临床已不难鉴别。

The differential diagnosis of the discitis and spinal tuberculosis on MRI

Objective：To discuss the differences betweet the discitis and spinal tuberculosis on MRI,so as to achieve the purpose of identifying.Methods：20 cases of discitis were proved by surgery or after the vertebral disc puncture clinically.Other 20 cases of spinal tuberculosis were confirmed clinically. Results：The differences betweet discitis and spinal tuberculosis on MRI are： ① Clinical manifestations： the intervertebral disc inflammation is pain,while the vertebral tuberculosis can be no clinical symptoms early;② Changes in the intervertebral disc： the disappearance of low signal fracture in the nucleus pulposus is obvious with T2WI-weighted in early discitis,and the narrow-gap change of intervertebral disc is the latter part of the performance,There will be changes of the vertebral disc in the vertebral tuberculosis on mid-and late stage;③ Changes in the adjacent vertebral bone： the performance of the vertebral disc is the adjacent upper and lower vertebral body parts or all of the symmetry of inflammatory,few fracture,while the vertebral bone in tuberculosis is moth eaten bone destruction,often multiple vertebral erosion,often associated with pathological fracture;④ Changes in the paraspinal soft tissue： there is more obvious changes in the paraspinal soft tissue in tuberculosis than vertebral discitis.Vertebral tuberculosis often involved the psoas major muscle,Intraspinal epidural space and the side of the intervertebral foramen,often makes spinal stenosis,while the discitis showen only a mild adjacent soft tissue swelling in the vertebral disc.Conclusion：Discitis and spinal tuberculosis have their own characteristics.The differential diagnosis will be no difficult by careful observation of intervertebral disc,vertebral body and paravertebral soft tissue changes,and combined with the clinical features.