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。