堡兰墅垡兰塑查!!!!至整垫查笙!!塑』坚型!里!E也曼∑21：垫型!：!!!!!!椎间盘炎与脊椎结核的MRI鉴别诊断赵尚开，李银喜，冉华(中国人民解放军第四七八医院医学影像科云南昆明650200)【摘要】目的：探讨椎间盘炎与脊柱结核在MRI上的不同点，从而达到鉴别的目的。方法：20例为经手术后或椎问盘穿刺术后临床证实的椎间盘炎．20例为临床证实的脊柱结核。结果：椎间盘炎与脊柱结核在MRI上的不同点表现在：①临床表现上：椎间盘炎疼痛症状明显．而椎体结核早期可无任何临床症状；②椎问盘改变上：早期椎间盘炎以T。WI加权像髓核内低信号裂隙征消失为明显．椎同盘变狭为后期表现，而椎体结核中后期椎问盘才会有改变；②相邻椎体骨质改变上：椎间盘炎表现为相邻的上、下两个椎体的部分或全部对称性炎性改变．少有椎体骨折．而椎体结核椎体骨质多呈虫蚀样破坏．常侵蚀多个椎体．常合并病理性骨折；④椎旁软组织改变上：椎体结核远比椎问盘炎明显．椎体结核常侵犯到腰大肌、椎管内硬膜外同隙及一侧椎间孔．常使椎管狭窄．而椎间盘炎仅表现为椎问盘旁软组织的轻度肿胀。结论：椎间盘炎与脊柱结核各有其特点．仔细观察椎间盘、椎体以及椎旁软组织上的改变．结合临床已不难鉴别。【关键词】椎间盘炎；脊柱结核；鉴别诊断；磁共振成像中图分类号：R68l；R445．2文献标识码：A文章编号：1006—90ll(2010)ll—1700～03ThedifferentiaIdia印吣iso“he施cit萱sandspi舱ltubercuI惦is蚰MRIZHA0S妇行碍-妇i。LjH行一“．RANH“口DP户口以，’l已州o，J优n暑i珂g。T．^P478胁H∞户i纽Zo，PLA．K“以优i行g650200．P．R．C^i开口【Abstract】objective：TodiscussthedifferencesbetweetthediscitisandspinaltuberculosisonMRI，soastoachievethepurposeofidentifying．I¨ethocb：20casesofdiscitiswereprovedbysurgeryorafterthevertebraldiscpunctureclinically．()ther20casesofspinaltuberculosiswereconf．rmedc“nically．Results：Thedifferencesbetweetdiscitisandspinaltubercu—losisonMRlare：①Clinicalmanifestations：theintervertebraIdiscinflammationispain．whilethevertebraltuberculosiscanbenoclinicalsymptomsearly；②ChangesintheintervertebraIdisc：thedisappearanceoflowsignalfractureinthenu-cIeuspuIposusisobviouswith1乙WI-weightedinearIydiscitis，andthenarrow—gapchangeofintervertebraldiscistheIat-terpartoftheperformance。Therewillbechangesofthevertebraldiscinthevertebraltuberculosisonmid—andlatestage；③Changesintheadjacentvertebralbone：theperformanceofthevertebraldiscistheadjacentupperandlowervertebraIbodypartsora儿ofthesymmetryofinflammatory．fewfracture．whiletheveftebralboneintuberculosisismotheatenbonedestruction．oftenmultiplevertcbralerosion．oftenassociatedwithpathologicalfracture；④Changesintheparaspi—nalsofttissue：thereismoreobviouschangesintheparaspinalsofttissLleintuberculosisthanvertebraldiscitis．VertebraltuberculosisofteninvolvedthepsoasmajormuscIe．Intraspinalepiduralspaceandthesideofrheintervertebralforamen．oftenmakesspinalstenosis．whilethediscitisshowenonlyamildadjacentso“tissueswelIinginthevertebraldisc．Con-cIusion：Discitisandspinaltuberculosishavetheirowncharacteristics．Thedifferentialdiagnosiswillbenodifficultbycare—fulobservationofintervertebraldisc．vertebralbodyandparavertebralsofttissuechanges．andcombinedwiththeclinicaIfeatures．【Keywords】Discitis；Spimltuberculosis；Di“eremialdiagnosis；Magneticresonanceimaging椎间盘炎与脊柱结核MRl上鉴别困难，特别是不典型病例时。现总结我院20例椎间盘炎与20例脊柱结核经手术及临床证实的MRI表现，并提出鉴别要点。作者简介：赵尚开(1973一)，男。pq川省绵阳市人。毕业于巾围人民解放军第一军医大学。主治医师，主婴从事医学影像学诊断．L作1700l材料与方法本组40例病例中，椎间盘...
