Pfirrmann 椎间盘退变的MRI分级标准

Pfirrmann 椎间盘退变的MRI(T2WI)分级标准

分级结构髓核与纤维环边界信号椎间盘高度

Ⅰ 质均，色亮白清高或等于脑脊液正常

Ⅱ 非均质，有或无水平带清高或等于脑脊液正常

Ⅲ 非均质，灰不清中等正常或轻度降低

Ⅳ 非均质，灰或黑消失中等或低信号正常或中度降低

Ⅴ 非均质，黑消失低信号椎间盘间隙塌陷

Figure 1. A-E, 腰椎间盘退变的分级系统，逐渐退变严重: Grade I: the structure of the disc is homogeneous, with bright hyperintense white signal intensity any normal disc height. Grade II: the structure of the disc is inhomogeneous, with the hyperintense white signal. The distinction between nucleus and annulus is clear, and the disc height is normal, with or without a horizontal gray bands. Grade III: the structure of the disc is inhomogeneous, with an intermittent gray signal intensity. The distinction between nucleus and annulus is unclear, and the disc height is normal or slightly decreased. Grade IV: the structure of the disc is inhomogeneous, with a hypointense dark gray signal intensity. The distinction between the nucleus and annulus is lost, the disc height is normal or moderately decreased. Grade V: the structure of the disc is inhomogeneous, with a hypointense black signal intensity. The distinction between nucleus and annulus is lost, and the disc space is collapsed. Grading is performed on T2-weighted Mid-sagittal fast spin-echo images.

Pfirrmann腰椎间盘突出MRI分级是一种很直观的分级，是MRI横断面上突出间盘和神经跟的关系确定的一种分级（如下图所示）。

Pfirrmann I级突出间盘与神经跟无接触

Pfirrmann II级突出间盘与神经根接触，神经根无移位

Pfirrmann III级突出间盘与神经根接触，神经根向后移位

Pfirrmann IV级突出间盘与神经根接触，神经根压至椎管后壁

有些学者将Pfirrmann分级作为衡量间盘突出严重程度的标准，并以此作为选择不同手术的适应症。如棘突间固定系统Wallis系统的适应症包括Pfirrmann II级、III级、IV级的间盘突出。