Dagirmanjian A, Schils J, McHenry M, Modic M T
Department of Radiology, Cleveland Clinic Foundation, OH 44195, USA.
AJR Am J Roentgenol. 1996 Dec;167(6):1539-43. doi: 10.2214/ajr.167.6.8956593.
The purpose of this study was to reevaluate previously reported MR imaging findings for vertebral osteomyelitis that include decreased signal intensity in the disk and adjacent vertebral bodies on T1-weighted images, increased signal intensity in the disk and adjacent vertebral bodies on T2-weighted images, loss of endplate definition on T1-weighted images, and contrast enhancement of the disk, adjacent vertebral bodies, and involved paraspinal and epidural soft tissues.
Medical records, radiographs, and MR scans of 37 patients with vertebral osteomyelitis with 41 levels of involvement were reviewed for agreement with reported MR imaging findings.
Ninety-five percent of the levels (39/41) showed decreased vertebral body signal intensity on T1-weighted images; 95% (39/41) had loss of endplate definition; 95% (37/39) had increased disk signal intensity on T2-weighted images; and 56% (22/39) had increased vertebral body signal intensity on T2-weighted images. Eighty-five percent of the levels (35/41) and 84% of patients (31/37) had both signal intensity changes of the vertebral body on T1-weighted images and signal intensity changes of the disk on T1-and T2-weighted images. Only 46% of the levels (19/41) and 49% of patients (18/37) had both vertebral body and disk changes on T1- and T2-weighted images. Contrast enhancement of the disk and vertebral body was seen in 94% of patients (17/18). Ring enhancement of paraspinal and epidural processes was found to correlate at surgery with abscess, and homogeneous enhancement was found to correlate with phlegmon.
Hypointense signal intensity in the vertebral body on T1-weighted images, abnormal disk signal intensity on both T1- and T2-weighted images, and contrast enhancement are the findings that indicate spinal infection most reliably.
本研究的目的是重新评估先前报道的椎体骨髓炎的磁共振成像（MR）表现，包括T1加权图像上椎间盘及相邻椎体信号强度降低、T2加权图像上椎间盘及相邻椎体信号强度增加、T1加权图像上终板轮廓消失，以及椎间盘、相邻椎体、受累的椎旁和硬膜外软组织的对比增强。
回顾了37例椎体骨髓炎患者（共累及41个椎体节段）的病历、X线片和MR扫描结果，以确定是否与报道的MR成像表现相符。
95%的椎体节段（39/41）在T1加权图像上显示椎体信号强度降低；95%（39/41）存在终板轮廓消失；95%（37/39）在T2加权图像上椎间盘信号强度增加；56%（22/39）在T2加权图像上椎体信号强度增加。85%的椎体节段（35/41）和84%的患者（31/37）在T1加权图像上椎体信号强度有变化，且在T1加权和T2加权图像上椎间盘信号强度也有变化。只有46%的椎体节段（19/41）和49%的患者（18/37）在T1加权和T2加权图像上椎体和椎间盘均有变化。94%的患者（17/18）可见椎间盘和椎体的对比增强。发现椎旁和硬膜外病变的环形增强在手术中与脓肿相关，而均匀增强与蜂窝织炎相关。
T1加权图像上椎体低信号强度、T1加权和T2加权图像上椎间盘信号异常以及对比增强是最可靠地提示脊柱感染的表现。
