Candida spondylitis: Comparison of MRI findings with bacterial and tuberculous causes

Candida spondylitis is relatively uncommon and is usually encountered as an opportunistic infection. We analyzed the MRI characteristics of biopsy-proven cases of Candida spondylitis, and compared the findings with bacterial or tuberculous spondylitis.

The study included patients with infectious spondylitis who underwent MRI and biopsy from 1998 to 2011 (60 patients; mean age 56 ± 18 years). MR images were analyzed with respect to the number of involved vertebrae, contrast enhancement pattern, signal intensity of spinal inflammatory masses on T2-weighted imaging, paraspinal abscess size, intervertebral disk destruction, subligamentous spread, and skip lesions. The Fisher exact test and analysis of variance were used for statistical analysis.

There were 10 cases of Candida spondylitis, and 29 and 21 cases of bacterial and tuberculous spondylitis, respectively. On MRI, disk destruction was seen in 50%, 93%, and 30% of Candida, bacterial, and tuberculous cases, respectively. Subligamentous spread of infection was noted in 22%, 10%, and 85%. Paraspinal inflammatory masses were seen in 100%, 100%, and 76%, and abscesses in 100%, 66%, and 90%, of Candida, bacterial, and tuberculous cases, respectively. Paraspinal inflammatory masses contained low T2 signal intensity portions in 80%, 21%, and 67%, and skip lesions were seen in 0%, 10%, and 14%, respectively. Small abscesses were noted in 100%, 76%, and 35% of Candida, bacteria, and tuberculosis infections, respectively. Candida involved 2.3 ± 0.4 vertebrae compared with 2.3 ± 0.9 and 3.0 ± 1.7 in bacterial and tuberculous, respectively. Differences in the three groups were statistically significant (p < 0.05) except for the number of involved vertebrae, and skip lesions.

Candida spondylitis can be suspected when infectious lesions contain low-signal spinal inflammatory masses on T2-weighted imaging, small paraspinal abscesses, and in immunocompromised patients.