成人非特异性化脓性脊柱炎MRI分型及其临床意义
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摘要
目的分析成人非特异性化脓性脊柱炎的MRI表现并进行分型。方法回顾性分析经病理确诊的34例化脓性脊柱炎患者资料,根据累及脊柱部位及表现进行MRI分型。结果根据MRI表现分为Ⅰ～Ⅴ型:Ⅰ型化脓性脊椎炎2例,椎体终板出现骨质侵蚀/破坏/水肿,相应椎间盘正常;Ⅱ型化脓性椎间盘炎2例,椎间盘信号异常而邻近椎体未见骨质破坏;Ⅲ型化脓性脊椎-间盘炎27例,同时出现椎体骨质破坏和相邻椎间盘信号异常,其中21例继发硬膜外间隙炎症;Ⅳ型化脓性小关节炎2例,均继发硬膜外间隙炎症及脊膜炎;Ⅴ型复合型1例,同时跨节段发生Ⅲ型和Ⅳ型。结论 MRI可准确显示化脓性脊柱炎受累部位、范围,分型有利于提高对化脓性脊柱炎病理机制的理解和诊断能力。
Objective To analyze MRI features of non-specific pyogenic spondylitis(PS) in adult, and to propose a new classification of PS. Methods Data of 34 patients with PS confirmed by pathology were retrospectively analyzed. The classification was based on the location of lesions and MRI performances of the involved spine columns. Results According to MRI performances, PS were divided into type Ⅰ—Ⅴ: Type Ⅰ PS(n=2), simple bone erosion/destruction/edema of vertebral endplates without involving corresponding intervertebral disc; type Ⅱ, pyogenic discitis(n=2), simple discitis without involvement of vertebral bodies; type Ⅲ, pyogenic spondylodiscitis(n=27), spondylodiscitis involving both intervertebral disc and adjacent vertebral bodies, and 21 cases with secondary epidural phlegmon; type Ⅳ, pyogenic facet joint infection(n=2), with epidural phlegmon/abscess and leptomeningitis; type Ⅴ, compound type(n=1), simultaneous trans-segments involved type Ⅲ and type Ⅳ together. Conclusion MRI can accurately show the location and extent of the involvement of PS. MRI classification is beneficial to improve understanding of the pathological mechanism and diagnostic ability of PS.
Objective To analyze MRI features of non-specific pyogenic spondylitis(PS) in adult, and to propose a new classification of PS. Methods Data of 34 patients with PS confirmed by pathology were retrospectively analyzed. The classification was based on the location of lesions and MRI performances of the involved spine columns. Results According to MRI performances, PS were divided into type Ⅰ—Ⅴ: Type Ⅰ PS(n=2), simple bone erosion/destruction/edema of vertebral endplates without involving corresponding intervertebral disc; type Ⅱ, pyogenic discitis(n=2), simple discitis without involvement of vertebral bodies; type Ⅲ, pyogenic spondylodiscitis(n=27), spondylodiscitis involving both intervertebral disc and adjacent vertebral bodies, and 21 cases with secondary epidural phlegmon; type Ⅳ, pyogenic facet joint infection(n=2), with epidural phlegmon/abscess and leptomeningitis; type Ⅴ, compound type(n=1), simultaneous trans-segments involved type Ⅲ and type Ⅳ together. Conclusion MRI can accurately show the location and extent of the involvement of PS. MRI classification is beneficial to improve understanding of the pathological mechanism and diagnostic ability of PS.
引文
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[14] 刘历,杨艺.化脓性椎间盘炎的MRI表现及误诊分析.医学影像杂志,2018,28(8):1359-1361.
[15] Ali R,Le Maitre CL,Richardson SM,et al.Connective tissue growth factor expression in human intervertebral disc:Implications for angiogenesis in intervertebral disc degeneration.Biotech Histochem,2008,83(5):239-245.
[16] Uchida K,Nakajima H,Yayama T,et al.Epidural abscess associated with pyogenic spondylodiscitis of the lumbar spine;evaluation of a new MRI staging classification and imaging findings as indicators of surgical management:A retrospective study of 37 patients.Arch Orthop Trauma Surg,2010,130(1):111-118.
[17] Sharif HS.Role of MR imaging in the management of spinal infections.AJR Am J Roentgenol,1992,158(6):1333-1345.
[18] Babic M,Simpfendorfer CS.Infections of the Spine.Infect Dis Clin North Am,2017,31(2):279-297.
[2] Kourbeti IS,Tsiodras S,Boumpas DT.Spinal infections:Evolving concepts.Curr Opin Rheumatol,2008,20(4):471-479.
[3] Rutges JP,Kempen DH,Dijk MV,et al.Outcome of conservative and surgical treatment of pyogenic spondylodiscitis:A systematic literature review.Eur Spine J,2016,25(4):983-999.
[4] Cheung WY,Luk KD.Pyogenic spondylitis.Int Orthop,2012,36(2):397-404.
[5] Aagaard T,Roed C,Dahl B,et al.Long-term prognosis and causes of death after spondylodiscitis:A Danish nationwide cohort study.Infect Dis (Lond),2016,48(3):201-208.
[6] Sheikh AF,Khosravi AD,Goodarzi H,et al.Pathogen identification in suspected cases of pyogenic spondylodiscitis.Front Cell Infect Microbiol,2017,7:60.
[7] Hadjipavlou AG,Mader JT,Necessary JT,et al.Hematogenous pyogenic spinal infections and their surgical management.Spine (Phila Pa 1976),2000,25(13):1668-1679.
[8] Yee DK,Samartzis D,Wong YW,et al.Infective spondylitis in southern Chinese:A descriptive and comparative study of ninety-one cases.Spine (Phila Pa 1976),2010,35(6):635-641.
[9] Pola E,Autore G,Formica VM,et al.New classification for the treatment of pyogenic spondylodiscitis:Validation study on a population of 250 patients with a follow-up of 2 years.Eur Spine J,2017,26(Suppl 4):479-488.
[10] Butler JS,Shelly MJ,Timlin M,et al.Nontuberculous pyogenic spinal infection in adults:A 12-year experience from a tertiary referral center.Spine (Phila Pa 1976),2006,31(23):2695-2700.
[11] Chang MC,Wu HT,Lee CH,et al.Tuberculous spondylitis and pyogenic spondylitis:Comparative magnetic resonance imaging features.Spine (Phila Pa 1976),2006,31(7):782-788.
[12] Dunbar JA,Sandoe JA,Rao AS,et al.The MRI appearances of early vertebral osteomyelitis and discitis.Clin Radiol,2010,65(12):974-981.
[13] 张译徽,朱新生,夏巴海提·伊明,等.MR椎体终板破坏分型鉴别诊断布鲁菌性脊柱炎与结核性脊柱炎.中国医学影像技术,2017,33(1):101-105.
[14] 刘历,杨艺.化脓性椎间盘炎的MRI表现及误诊分析.医学影像杂志,2018,28(8):1359-1361.
[15] Ali R,Le Maitre CL,Richardson SM,et al.Connective tissue growth factor expression in human intervertebral disc:Implications for angiogenesis in intervertebral disc degeneration.Biotech Histochem,2008,83(5):239-245.
[16] Uchida K,Nakajima H,Yayama T,et al.Epidural abscess associated with pyogenic spondylodiscitis of the lumbar spine;evaluation of a new MRI staging classification and imaging findings as indicators of surgical management:A retrospective study of 37 patients.Arch Orthop Trauma Surg,2010,130(1):111-118.
[17] Sharif HS.Role of MR imaging in the management of spinal infections.AJR Am J Roentgenol,1992,158(6):1333-1345.
[18] Babic M,Simpfendorfer CS.Infections of the Spine.Infect Dis Clin North Am,2017,31(2):279-297.
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