Ledermann Hans Peter, Schweitzer Mark E, Morrison William B, Carrino John A
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Radiology. 2003 Aug;228(2):506-14. doi: 10.1148/radiol.2282020752. Epub 2003 Jun 11.
To systematically evaluate magnetic resonance (MR) imaging findings described as being indicative of spinal infection in patients with proven spinal infection.
Contrast material-enhanced spinal MR images obtained in 46 consecutive patients (22 women, 24 men; mean age, 58.2 years) with culture or histologic examination results positive for spinal infection were systematically evaluated by two observers. Tuberculous and postoperative infections were excluded. Disk signal intensity and disk height, presence of the nuclear cleft, vertebral signal intensity alterations, endplate erosions on T1-weighted MR images, and presence of paraspinal or epidural inflammation were evaluated. Patient charts and surgical reports were reviewed.
In the 44 patients with disk infection, MR imaging criteria with good to excellent sensitivity included presence of paraspinal or epidural inflammation (n = 43, 97.7% sensitivity), disk enhancement (n = 42, 95.4% sensitivity), hyperintensity or fluid-equivalent disk signal intensity on T2-weighted MR images (n = 41, 93.2% sensitivity), and erosion or destruction of at least one vertebral endplate (n = 37, 84.1% sensitivity). Effacement of the nuclear cleft was only applicable in 18 patients (n = 15, 83.3% sensitivity). Criteria with low sensitivity included decreased height of the intervertebral space (n = 23, 52.3% sensitivity) and disk hypointensity on T1-weighted MR images (n = 13, 29.5% sensitivity). Involvement of several spinal levels occurred in seven (16%) patients. Other spinal infections included isolated vertebral osteomyelitis (n = 1) and primary epidural abscess (n = 1).
Most MR imaging criteria commonly used to diagnose disk infections offer good to excellent sensitivity. In atypical manifestations of proven spinal infections, however, some of the classically described MR imaging criteria may not be observed.
系统评估在经证实患有脊柱感染的患者中，那些被描述为提示脊柱感染的磁共振（MR）成像表现。
由两名观察者对46例连续患者（22名女性，2名男性；平均年龄58.2岁）的增强脊柱MR图像进行系统评估，这些患者的培养或组织学检查结果显示脊柱感染呈阳性。排除结核和术后感染。评估椎间盘信号强度和椎间盘高度、核裂隙的存在、椎体信号强度改变、T1加权MR图像上的终板侵蚀以及椎旁或硬膜外炎症的存在。查阅患者病历和手术报告。
在44例椎间盘感染患者中，敏感性良好至极佳的MR成像标准包括椎旁或硬膜外炎症的存在（n = 43，敏感性97.7%）、椎间盘强化（n = 42，敏感性95.4%）、T2加权MR图像上椎间盘高信号或类似液体的信号强度（n = 41，敏感性93.2%）以及至少一个椎体终板的侵蚀或破坏（n = 37，敏感性84.1%）。核裂隙消失仅适用于18例患者（n = 15，敏感性83.3%）。敏感性较低的标准包括椎间隙高度降低（n = 23，敏感性52.3%）和T1加权MR图像上椎间盘低信号（n = 13，敏感性29.5%）。7例（16%）患者出现多个脊柱节段受累。其他脊柱感染包括孤立性椎体骨髓炎（n = 1）和原发性硬膜外脓肿（n = 1）。
大多数常用于诊断椎间盘感染的MR成像标准具有良好至极佳的敏感性。然而，在经证实的脊柱感染的非典型表现中，一些经典描述的MR成像标准可能未被观察到。
