腰椎间盘退变的X线、MRI表现与病理对照

目的 观察腰椎间盘退变的病理变化及其MRI表现。方法 13具腰椎尸检标本共31个椎间盘均进行X线钼靶检查，其中5具标本的20个椎间盘进行MR检查，将X线及MRI所见与31个椎间盘的87个层面的病理大切片进行对照。结果 31个椎间盘病理均可见不同程度的纤维环退变，在T2WI上20个椎间盘的内外纤维环中均出现带状、片状高信号，或椎间盘大部呈高信号。病理见22（22／31）个纤维环成角折曲突向髓核（内折），18（18／31）个纤维环成角折曲突向周边（外折）；在T1W1和T1WI内折表现为椎间盘内突向髓核成角折曲的低信号，外折表现为椎间盘内突向周边的折角低信号。病理见20（20／31）个椎间盘髓核内可见坏死的细胞碎渣，在T2WI表现为髓核中斑点状低信号（14／20）。Schmorl结节见于7个椎间盘，病理显示为椎间盘内的组织突破软骨终板进行入椎体内形成结节，7个Schmorl结节在T2WI均呈高信号。病理显示2个椎间盘纤维环内有大的裂隙形成，在T2WI表现为低信号带。病理显示6个椎间盘退变，纤维组织增生呈团块状、分支状和带状横贯于椎间盘之中，在T2WI表现为椎间盘中低信号带。平片示唇样增生3个椎体，Schmorl结节7个椎体；椎体上下面骨板硬化，呈孤形凹陷和锯齿状骨质侵蚀11个椎体，后者病理见凹陷处软骨板消失。结论 MRI对腰椎间盘退变有较高的诊断价值，X线平片可以间接显示软骨终板的消失。

The comparative study of radiograph, MRI and pathology in degeneration of lumbar intervertebral disc

Objective To investigate the pathology and MRI features of the degeneration of lumbar intervertebral discs (IVD). Methods Thirteen human lumbar spine segments with 31 IVDs were harvested from fresh cadavers. High quality radiographs were taken for all specimens. Five segments with 20 IVD underwent MRI. Then, the radiographic and MRI findings were correlated with corresponding 87 pathologic sections. Results Variant degeneration was observed in pathologic sections in all 31 IVDs. With MRI T 2WI images, 20 IVDs showed linear and spotty high signal in the annular fibers, or most of the IVD showed high signal. On pathologic cuts, 22 of 31 IVDs showed infolding of annular fibers, 18 of 31 showed outfolding of annular fibers. On MRI T 1WI and T 2WI images, infolding and outfinding of annular fibers were seen as low signal. 20 of 31 IVDs had necrotic debris of cells in the nucleus pulposus. 14 of 20 demonstrated spotty low signal areas on MRI T 2WI images.7 Schmorl nodules were found. On pathologic sections Schmorl nodules were seen as IVD tissue protruding into vertebral endplates, they were seen as high signal on T 2WI images. Two large fissures found on sections were seen as low signal on T 2WI. Degenerative fibrosis seen on 6 IVD, which showed intermediate signal on T 2WI images. However, radiographs only demonstrated osteophytes on 3 vertebrae, 7 Schmorl's nodules. Sclerotic, concave and irregular endplates were seen in 11 IVDs, the latter is the indication of cartilaginous endplate disruption. Conclusion MRI is very useful in demonstrating the degeneration of IVD, radiograph is able to indirectly show the disapperance of cartilaginous endplate.