Seymour R, Williams L A, Rees J I, Lyons K, Lloyd D C
Department of Radiology, Cardiff Royal Infirmary, UK.
Clin Radiol. 1998 May;53(5):363-8. doi: 10.1016/s0009-9260(98)80010-x.
Schmorl's nodes, the result of previous intraosseous disc herniation (IODH), are a common incidental finding on plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). Acute IODH can, however, cause severe back pain, and the radiological features may also lead to inappropriate suspicion of malignancy or infection. We present eight cases of acute IODH in order to illustrate how the correct diagnosis can be made by MRI. In six cases isotope bone scintigraphy had been performed, demonstrating focal increased activity at the site of IODH. MRI can reinforce the concern about serious underlying pathology by the demonstration of marrow oedema, which may be localized around the disc herniation or extensive, extending throughout the vertebral body and into the pedicles. The key to the correct diagnosis is the recognition of the endplate defect and disc herniation. In three cases the diagnosis may have been possible from plain radiographs in which disc calcification visible on previous radiographs had migrated into an intraosseous location.
施莫尔氏结节是既往骨内椎间盘突出（IODH）的结果，在X线平片、计算机断层扫描（CT）和磁共振成像（MRI）上是常见的偶然发现。然而，急性IODH可导致严重背痛，其影像学特征也可能导致对恶性肿瘤或感染的不恰当怀疑。我们报告8例急性IODH病例，以说明如何通过MRI做出正确诊断。6例患者进行了同位素骨扫描，显示IODH部位局部放射性活性增加。MRI可通过显示骨髓水肿加重对严重潜在病变的担忧，骨髓水肿可能局限于椎间盘突出周围或广泛存在，延伸至整个椎体并累及椎弓根。正确诊断的关键是识别终板缺损和椎间盘突出。在3例病例中，根据X线平片可能已做出诊断，其中先前X线片上可见的椎间盘钙化已迁移至骨内位置。
