脊柱常见疾病的MRI诊疗.pptx

四川省骨科医院放射科吴俊华MRI常规扫描方位MRI常规扫描序列正常脊柱MRI解剖脊柱主要组成脊椎骨椎间盘脊髓韧带周围肌肉正常脊柱MR信号表现T1WI信号T2WI信号TIRM(压脂)信号骨髓腔:等-灰等-灰等-灰骨皮质：低-黑低-黑低-黑椎间盘髓核:等-灰高-白高-白椎间盘纤维环：低-黑低-黑低-黑脑脊液：低-黑高-白高-白脊髓:等-灰等-灰等-灰神经：等-灰等-灰等-灰韧带：低-黑低-黑低-黑脂肪：高-白高-白低-黑肌肉：等-灰低-黑等-灰正常脊柱全貌正常椎体正常椎间盘正常椎小关节正常脊髓及蛛网膜下腔正常马尾及黄韧带脊柱常见病变脊柱退变脊柱退变椎间盘病变椎间盘变性椎间盘突出L4/5椎间盘突出（中央型）L4/5椎间盘突出（旁中央型）椎间盘膨出周缘性膨隆椎间盘脱出纤维环破裂髓核游离许莫氏结节依据椎间盘相邻椎体骨髓信号异常分为三型I型：骨髓水肿（T1WI像低信号-黑，T2WI像高信号-白）II型：脂肪沉积（T1WI像高信号-白，T2WI像较高信号-灰白）III型：骨质硬化（T1WI像、T2WI像均为低信号-黑）参考文件：ModicMT,MasarykTJ,RossJS,etal.Imagingofdegenerativediskdisease[J].Radiology,1988,168(1):177-86.TypeIDecreasedsignalonT1,andincreasedsignalonT2.Representsmarrowedema.Associatedwithanacuteprocess.HistologicalexaminationshowsdisruptionandfissuringoftheendplateandvascularizedfibroustissueswithintheadjacentmarrowTypeII-themostcommontypeIncreasedsignalonT1,andisointenseorslightlyhyperintensesignalonT2.Representsfattydegenerationofsubchondralmarrow.Associatedwithachronicprocess.Histologicalexaminationshowsendplatedisruptionwithyellowmarrowreplacementintheadjacentvertebralbody.TypeIchangesconverttoTypeIIchangeswithtime,whileTypeIIchangesseemtoremainstable.TypeIIIDecreasedsignalonbothT1andT2.Correlatewithextensivebonysclerosisonplainradiographs.Histologicalexaminationshowsdensewovenbone;hence,nomarrowtoproduceMRIsignal.I型II型III型JonesA,ClarkA,FreemanBJ,etal.TheModicclassification:inter-andintraobservererrorinclinicalpractice[J].Spine(PhilaPa1976),,30(16):1867-9.“Wehaveshownthattheclassificationisbothreliableandreproducible.Itissimpleandeasytoapplyforobserversofvaryingclinicalexperience.Wethereforerecommenditsuseinclinicalresearchandpractice.”请思索：脊柱退变椎小关节退变影像学诊疗分级：Weishaupt在1999年提出依据CT、MRI将腰椎小关节退变程度分为4级,是当前公认小关节退变影像学分级法。参考文件：DominikWeishaupt,MarcoZanetti,NorbertBoos,etal.MRimagingandCTinosteoarthritisofthelumbarfacetjoints[J].SkeletalRadiol(1999)28:215-219.正常人腰椎小关节影像学表现关节间隙正常(2mm)关节间隙变窄(＜2mm)伴有或不伴相关节突肥大和(或)轻微骨赘形成关节间隙变窄(＜2mm)中度关节突肥大和(或)中度骨赘形成及少许软骨下骨侵蚀关节间隙变窄(＜2mm)重度关节突肥大和(或)巨大骨赘形成，严重软骨下骨侵蚀和(或)软骨下囊肿可见脊柱退变上位椎体相对于下位椎体发生移位前方滑脱、