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Pseudosparing of the endplate: a potential pitfall in using MR imaging to diagnose infectious spondylitis
L J Wolansky1, R F Heary, T Patterson
1Department of Radiology, New Jersey Medical School/UMDNJ, Newark 07103, USA.
Objective:
The objective of this study was to describe a potential pitfall in using MR imaging to diagnose infectious spondylitis called "pseudosparing" of the endplate, in which the diseased endplate appears to be better defined than a healthy endplate.
Conclusion:
Poor definition of the endplate is a classic radiographic finding in infectious spondylitis; on MR imaging, however, increased conspicuity, or "pseudosparing," was common in our study. Pseudosparing occurs when the normal chemical shift artifact seen in healthy endplates is lost as a result of infiltration of the bone marrow by a pathologic process.
Insights
Magnetic resonance (MR) imaging can misdiagnose infectious spondylitis due to "pseudosparing" of the vertebral endplate. This occurs when inflammation obscures the normal artifact, making diseased areas appear clearer than healthy ones.
Area of Science:
- Radiology
- Medical Imaging
- Orthopedics
Background:
- Infectious spondylitis diagnosis relies on identifying vertebral endplate abnormalities.
- Classic radiographic findings include poor endplate definition.
- Magnetic resonance (MR) imaging is a key diagnostic tool.
Purpose of the Study:
- To describe a diagnostic pitfall in MR imaging of infectious spondylitis.
- To identify and define the phenomenon of endplate "pseudosparing" on MR imaging.
- To differentiate true endplate pathology from imaging artifacts.
Main Methods:
- Review of MR imaging studies in patients with confirmed infectious spondylitis.
- Analysis of endplate conspicuity and definition on MR images.
- Correlation of imaging findings with pathological processes.
Main Results:
- "Pseudosparing," where diseased endplates appear more defined than healthy ones, was a common finding.
- This phenomenon is attributed to the loss of normal chemical shift artifact.
- Pathologic infiltration of bone marrow disrupts the artifact in affected vertebrae.
Conclusions:
- "Pseudosparing" on MR imaging can mimic a healthy endplate, potentially leading to misdiagnosis.
- Understanding this artifact is crucial for accurate MR imaging interpretation in infectious spondylitis.
- The loss of chemical shift artifact due to marrow infiltration is the underlying mechanism.