【作者】 陈欢欢；

【导师】 赵凤东；

【作者基本信息】 浙江大学 ， 骨科学（专业学位）， 2014， 硕士

【摘要】 目的：通过CT、MRI及组织学分析探讨腰椎间盘后方高信号区(high-intensity zone,HIZ)的病理学性质。方法：选取下腰痛病人中其MRI T2WI上存在局限性高信号区的病人41例,男23例,女18例,年龄33-50岁,平均年龄38岁,按照其MRI上HIZ的特点分为两组,即T2加权像高信号,T1加权像低(或等)信号者为A组,29例；而T1，T2加权像上均为高信号者为B组,12例。所有病例均同时进行CT和X线检查,A组26例进行椎间盘造影以及疼痛激发试验；A组15例、B组7例接受手术治疗,并对手术中切取的HIZ区域标本进行HE染色和/或免疫组化染色,进行比较分析。结果：A组中所有病例的CT、MRI检查均显示椎间盘退变,21例椎间盘造影以及疼痛激发试验为造影阳性以及疼痛复制,并显示为纤维环破裂,其中15例阳性者接受手术治疗,另5例阴性。手术中切取的HIZ区域标本HE染色显示为纤维环破裂伴随肉芽组织形成,CD34染色可见HIZ区域见新生血管,CD68见HIZ区域内多量染色阳性的巨噬细胞；而B组中,所有病例椎间盘在CT影像上显示为后方纤维环钙化或骨化,HE染色可见明显的钙化灶和钙化的潮汐线形成。结论：T2WI上在腰椎间盘后方为局限性高信号区,而TIWI上表现为局限性的较低或者等信号者意味着通常所指的纤维环破裂伴随肉芽组织长入；而T2WI和T1WI上的共同高信号区可能是钙化或骨化灶,因此,传统HIZ的概念可能需要一定的修正,结合CT检查可能更有意义。更多还原

【Abstract】 Objective:to determine the exact essence of HIZ of lumbar intervertebral disc by means of CT, MRI and histomorphology:annular tear, calcification or ossification of annulous fibrosus? Methods:the HIZ of the lumbar disc on MRI in41patients with low back pain were identified and divided into two groups according to the characteristics of HIZ:group A, the high intensity on MRI T2WI and low intensity on MRI T1WI;29patients; group B, the HIZ on MRI T2WI was found as high intensity zone on T1WI as well,12patients. All these patients underwent CT scan on the targeted level.26patients from group A,78discs were performed discography and provocative test;15patients from group A and7cases from group B underwent surgery and the posterior annulous fibrosus containing HIZ were harvested for histologic analysis to confirm the essence of HIZ. Results:all the lumbar discs in group A showed degeneration by CT and MRI scan, for these26patients who underwent discography,21were positive and annular tear, and15of them accepted operation. Histomorphology examination showed annular tear combined with granulation tissue in the outer annulus fibrosus. In group B, all those targeted discs showed calcified or ossified lesion on the posterior annular on CT scan, HE staining showed calcification or ossification of the posterior annulus fibrosus with frontier line. Conclusions:The HIZ on MRI T2WI which was found as low intensity zone on MRI T1WI possibly refers as annular tear combined with granulation in-growth, on the other hand, the HIZ both on MRI T2WI and T1WI might be calcification or ossification of the posterior annulus fibrosus of the targeted discs. From this point of view, the conventional concept of HIZ should be modified as HIZ on MRI T2WI, but low intensity zone on MRI T1WI, in addition, CT scan might be helpful in the distinguished diagnosis.更多还原