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Magnetic resonance imaging of disc space infection revisited: temporal changes
Shaoyin Duan1, Bingqiang Xu2, Gina Di Primio3
1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Canada; Department of Medical Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian 361004, China.
Background:
Magnetic resonance imaging (MRI) has advantages in showing pathologic changes of disc space infection, which is important in clinical treatment. The purpose of this study was to describe the MRI findings of disc space infections in relation to chronicity.
Methods:
MRI of 60 patients from January 1, 2002 to April 30, 2012 in Ottawa Hospital were retrospectively evaluated by two radiologists blindly. All patients had histological confirmation, with 55 having microbiological confirmation as well. These patients were divided into acute (n = 18), subacute (n = 21) and chronic (n = 21) based on histological findings. The following potential signs of MRI finding were assessed: marrow edema, endplate erosions, disk fluid and height change, paraspinal mass, epidural collection, facet fluid and enhancement in the marrow, disc, paraspinal mass, and epidural involvement. Statistical analysis consisted of t- or F-tests and chi-square test.
Results:
In the 60 patients, 83 infected discs (single disc in 45 patients, 2-4 discs in 15 patients) were found, including 22 discs in the acute group, 30 discs in the subacute group, and 31 discs in the chronic group. There was a significant difference in the extent of marrow edema between the acute, subacute and chronic groups (P < 0.05), with a gradually increasing extent from acute to chronic. The extent of endplate erosions increased with chronicity, but was not statistically significant. There were significant differences in the disc fluid, epidural collection, and disc enhancement among the acute, subacute and chronic groups, as well as the facet fluid between acute and chronic groups (P < 0.05). There were no significant differences in the present probability of disc height loss, paraspinal mass, and marrow enhancement among the three groups (P > 0.05).
Conclusions:
From acute to chronic infections, the extent of marrow edema and endplate erosions appeared to gradually increase. Epidural collections and facet fluid are most frequently found in the acute group, while disc fluid and disc enhancement are more common in the chronic patients.
Insights
Magnetic resonance imaging (MRI) reveals increasing marrow edema and endplate erosions in disc space infections over time. Acute infections show more epidural collections and facet fluid, while chronic cases present with more disc fluid and enhancement.
Area of Science:
- Radiology
- Infectious Diseases
- Spinal Imaging
Background:
- Magnetic resonance imaging (MRI) is crucial for diagnosing disc space infections.
- Understanding MRI findings in relation to infection chronicity aids clinical management.
Purpose of the Study:
- To characterize MRI findings of disc space infections.
- To correlate MRI findings with the chronicity (acute, subacute, chronic) of infection.
Main Methods:
- Retrospective evaluation of MRI scans from 60 patients with confirmed disc space infections.
- Assessment of specific MRI features including marrow edema, endplate erosions, and fluid collections.
- Categorization of infections into acute, subacute, and chronic based on histological findings.
Main Results:
- Marrow edema and endplate erosions showed a progressive increase with infection chronicity.
- Significant differences in disc fluid, epidural collection, and disc enhancement were observed across chronicity groups.
- Facet fluid was more common in acute infections, while disc fluid and enhancement were more prevalent in chronic infections.
Conclusions:
- MRI findings evolve with the chronicity of disc space infections.
- Marrow edema and endplate erosions are key indicators of increasing infection duration.
- Distinct MRI features help differentiate between acute and chronic disc space infections.
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