脊柱感染抗感染治疗后不同MRI征象恢复模式分析

Different Recovery Patterns of MRI Findings after Antimicrobial Therapy for Spinal Infection

摘要: 目的：探讨脊柱感染抗感染治疗后不同MRI征象的恢复模式及其与临床改善、炎症指标变化的一致性。方法：回顾性分析44例接受抗感染治疗并具有治疗前后MRI随访资料的脊柱感染患者。根据随访MRI变化方向，将椎旁脓肿、硬膜外脓肿、椎体骨髓信号及椎间盘等征象分为改善方向、稳定和进展方向。采用Cohen κ检验评价MRI征象变化方向与临床好转及CRP下降≥50%的一致性。结果：44例患者中41例(93.2%)治疗后临床好转。不同MRI征象恢复模式存在差异，椎旁脓肿和硬膜外脓肿改善比例高于椎体骨髓信号及椎间盘改变。临床好转及CRP下降与脓肿类MRI征象变化方向的一致性较高，而与椎体骨髓信号变化的一致性较低。部分患者出现软组织脓肿改善而骨髓信号未同步改善。结论：抗感染治疗后，临床改善与MRI变化并非完全同步，不同MRI征象具有不同恢复节律。软组织脓肿相关征象可能较早反映治疗反应，而骨髓信号及椎间盘异常可持续存在。随访MRI应结合临床表现及炎症指标综合评价，不能单独依据持续性骨髓或椎间盘异常判断治疗失败。

Abstract: Objective: To investigate the recovery patterns of different magnetic resonance imaging (MRI) findings after anti-infective treatment for spinal infection and to evaluate their consistency with clinical improvement and inflammatory marker changes. Methods: This retrospective study included 44 patients with spinal infection who received anti-infective treatment and underwent MRI examinations before and after treatment. Based on follow-up MRI changes, imaging findings including paraspinal abscess, epidural abscess, vertebral bone marrow signal abnormality, and intervertebral disc involvement were categorized as showing improvement, stability, or progression. Cohen’s kappa analysis was performed to assess the consistency between MRI changes and clinical improvement or a ≥50% decrease in C-reactive protein (CRP). Results: Among the 44 patients, 41 (93.2%) showed clinical improvement after treatment. Different MRI findings demonstrated distinct recovery patterns. The proportions of patients showing improvement in paraspinal abscess and epidural abscess were higher than those with improvement in vertebral bone marrow signal abnormalities and intervertebral disc changes. Clinical improvement and CRP reduction showed better consistency with improvement of abscess-related MRI findings, whereas the consistency with vertebral bone marrow signal changes was relatively lower. In some patients, soft tissue abscesses improved while vertebral bone marrow signal abnormalities persisted. Conclusion: After anti-infective treatment for spinal infection, clinical improvement and MRI changes are not completely synchronous. Different MRI findings exhibit distinct recovery patterns. Abscess-related soft tissue findings may reflect treatment response earlier, whereas vertebral bone marrow signal abnormalities and intervertebral disc changes may persist despite clinical improvement. Follow-up MRI findings should be interpreted in combination with clinical manifestations and inflammatory markers, and persistent bone marrow or intervertebral disc abnormalities alone should not be considered evidence of treatment failure.