Carragee E J
Department of Orthopaedic Surgery, Stanford University School of Medicine, California, USA.
Spine (Phila Pa 1976). 1997 Apr 1;22(7):780-5. doi: 10.1097/00007632-199704010-00015.
Retrospective chart review of 103 cases.
To describe the clinical use of magnetic resonance imaging in a pyogenic vertebral osteomyelitis.
Long delays in diagnosing pyogenic vertebral osteomyelitis of the spine have been shown in many reports. Magnetic resonance imaging has been advocated as the imaging method of choice in suspected spinal infections. The use, accuracy, and timing of magnetic resonance imaging in pyogenic vertebral osteomyelitis have not been reported in a large series.
In 103 patients with pyogenic vertebral osteomyelitis who underwent magnetic resonance imaging at or before the time of diagnosis, the author reviewed the clinical findings and results of the magnetic resonance imaging, timing with respect to symptom duration and diagnosis, and accuracy of readings in detecting spinal infection. Follow-up magnetic resonance imaging reports also were reviewed.
Magnetic resonance imaging appeared to give the correct diagnosis or suggest pyogenic vertebral osteomyelitis as a possible diagnosis in 55% and 36% of cases, respectively, with less than 2 weeks of symptoms. After 2 weeks, the percentages of correct and possible diagnoses of pyogenic vertebral osteomyelitis increased to 76% and 20%, respectively. Magnetic resonance imaging was obtained within 1 month of the start of symptoms in 73% of cases. The diagnosis was made within 1 month in the most cases as well, compared with a 2- to 6-month delay in most series. Follow-up magnetic resonance images often gave impressions of progressive disease, where the clinical picture appeared to improve.
Magnetic resonance imaging is valuable in suggesting the diagnosis even very early in the clinical course of pyogenic vertebral osteomyelitis. Its use may eliminate significant delays in diagnosis. The use of magnetic resonance imaging in following the therapeutic response remains to be defined.
对103例病例进行回顾性图表分析。
描述磁共振成像在化脓性脊椎骨髓炎中的临床应用。
许多报告显示，脊柱化脓性脊椎骨髓炎的诊断存在长时间延误。磁共振成像被推荐为疑似脊柱感染的首选成像方法。尚未有大量系列报道化脓性脊椎骨髓炎中磁共振成像的使用、准确性及时机。
对103例在诊断时或诊断前接受磁共振成像检查的化脓性脊椎骨髓炎患者，作者回顾了临床发现、磁共振成像结果、症状持续时间与诊断的时间关系以及检测脊柱感染时读数的准确性。还回顾了随访磁共振成像报告。
对于症状持续时间少于2周的病例，磁共振成像分别在55%和36%的病例中给出了正确诊断或提示化脓性脊椎骨髓炎为可能诊断。2周后，化脓性脊椎骨髓炎正确诊断和可能诊断的百分比分别增至76%和20%。73%的病例在症状开始后1个月内进行了磁共振成像检查。大多数病例也在1个月内做出了诊断，而大多数系列报道的诊断延迟为2至6个月。随访磁共振图像常显示病情进展，而临床情况似乎有所改善。
即使在化脓性脊椎骨髓炎临床病程的早期，磁共振成像对于提示诊断也很有价值。其应用可消除诊断中的显著延迟。磁共振成像在监测治疗反应方面的应用仍有待确定。
