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Spinal epidural abscess: correlation between MRI findings and outcome
G A Tung1, J W Yim, L A Mermel
1Department of Diagnostic Imaging, Brown University School of Medicine, Rhode Island, USA. Glenn_Tung@brown.edu
Abstract:
Our purpose was to determine if specific MRI findings in spinal epidural abscess (SEA), at the time of diagnosis, are associated with the clinical outcome. The clinical records and MRI studies of 18 patients with SEA were reviewed and follow-up was obtained from the outpatient medical record, telephone interview, or both. The association between findings on contrast-enhanced MRI and clinical outcome (weakness, neck or back pain, and incomplete functional recovery) was evaluated. With univariate analysis, narrowing of 50% or more of the central spinal canal (P = 0.03), peripheral contrast-enhancement (P = 0.05), and abnormal spinal cord signal intensity (P = 0.05) were associated with weakness at follow-up. Persistent neck or back pain was associated with spinal canal narrowing (P = 0.02), peripheral contrast-enhancement (P = 0.02), and an abscess longer than 3 cm (P = 0.04) on MRI. Incomplete clinical recovery was associated with both abscess length (P = 0.01) and the severity of canal narrowing (P = 0.01). Abscess length, enhancement pattern, and severity of canal narrowing can be incorporated in a grading system that can be used to predict outcome.
Insights
Specific MRI findings in spinal epidural abscess (SEA) correlate with patient outcomes. Key indicators like spinal canal narrowing and abscess size predict weakness, pain, and incomplete recovery, aiding in outcome prediction.
Area of Science:
- Radiology
- Neurology
- Infectious Disease
Background:
- Spinal epidural abscess (SEA) is a serious condition requiring prompt diagnosis and management.
- Predicting clinical outcomes in SEA patients can be challenging.
- Magnetic Resonance Imaging (MRI) is crucial for diagnosing SEA.
Purpose of the Study:
- To investigate the association between specific MRI findings at diagnosis and clinical outcomes in patients with SEA.
- To identify MRI features that predict neurological deficits and functional recovery.
- To explore the potential for an MRI-based grading system for outcome prediction.
Main Methods:
- Retrospective review of clinical records and MRI studies for 18 patients diagnosed with SEA.
- Evaluation of contrast-enhanced MRI findings, including spinal canal narrowing, enhancement patterns, and abscess characteristics.
- Correlation of MRI findings with clinical outcomes such as weakness, pain, and functional recovery via univariate analysis.
Main Results:
- Significant associations were found between MRI findings and clinical outcomes.
- Spinal canal narrowing (≥50%), peripheral contrast enhancement, and abnormal spinal cord signal intensity correlated with follow-up weakness.
- Abscess length (>3 cm) and spinal canal narrowing were linked to persistent pain and incomplete functional recovery.
Conclusions:
- Specific contrast-enhanced MRI findings in spinal epidural abscess are predictive of clinical outcomes.
- Spinal canal narrowing, abscess length, and enhancement patterns are key indicators for predicting weakness, pain, and recovery.
- An MRI-based grading system incorporating these factors could improve prognostication for SEA patients.