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Imaging of spinal infection
1Institute of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität, GroBhadern, Munich, Germany. axel.staebler@ikra.med.uni-muenchen.de
Abstract:
MR imaging is the modality of choice for the detection, staging, and differential diagnosis of inflammatory disorders of the spine. Infectious spondylitis is characterized by the involvement of two adjacent vertebrae and the intervening disk with severe BME and early destruction of the end plates. The disk space is narrowed and typically exhibits water-equivalent signal intensity on T2-weighted or STIR images. Prevertebral and epidural extensions, abscess formation, enhancement of the BME, the disk space, and the surrounding granulation tissue are well demonstrated by gadolinium-enhanced images. Cervical spondylitis frequently involves more than one level. Bone marrow abnormalities may be subtle at this level and increased signal intensity of the disk space on T2-weighted or STIR images is an important finding. The risk for neurologic complications is increased. Granulomatous infections caused by tuberculosis, brucellosis, fungi, and parasites, including hydatid disease (Echinococcus), are frequently associated with imaging findings different from those seen with nonspecific bacterial infection. In patients with chronic infectious spondylitis, diffuse reactive bone marrow changes with decreased signal intensity on T1-weighted images, increased signal intensity on T2-weighted and STIR images, and increased uptake after gadolinium administration may occur. This phenomenon is probably caused by reactive bone marrow stimulation, simulating diffuse hematologic neoplastic disease. Erosive intervertebral osteochondrosis with bandlike disk gadolinium enhancement and BME, which is commonly associated with local pain, is the most important differential diagnosis of bacterial spondylitis.
Insights
Magnetic resonance (MR) imaging is crucial for diagnosing spinal inflammatory disorders. It helps differentiate infections like spondylitis, revealing characteristic changes in vertebrae and discs, aiding in treatment planning.
Area of Science:
- Radiology
- Spinal Imaging
- Infectious Disease
Background:
- Magnetic resonance (MR) imaging is the primary tool for evaluating spinal inflammatory conditions.
- Infectious spondylitis involves adjacent vertebrae and discs, showing bone marrow edema (BME) and endplate destruction.
Purpose of the Study:
- To detail MR imaging findings in spinal inflammatory disorders.
- To differentiate infectious spondylitis from other conditions.
Main Methods:
- Review of MR imaging characteristics of infectious spondylitis.
- Analysis of imaging findings including BME, disk changes, and enhancement patterns.
Main Results:
- MR imaging detects vertebral and disk abnormalities, including BME and signal changes on T2-weighted/STIR images.
- Gadolinium enhancement highlights infections, abscesses, and granulation tissue.
- Granulomatous infections and chronic spondylitis show distinct patterns, potentially mimicking neoplastic disease.
Conclusions:
- MR imaging is essential for diagnosing and staging spinal infections.
- Characteristic imaging findings aid in differentiating bacterial from granulomatous spondylitis.
- Erosive osteochondrosis is a key differential diagnosis for bacterial spondylitis.