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Updated: Jan 13, 2026
In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Clinical Utility of Diffusion-Weighted Imaging in Spinal Infections
Rebecca A Dumont1, Nayela N Keen1, Courtnay W Bloomer1
1Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Rm. L-358, 94143-0628, San Francisco, CA, USA.
Purpose:
Both laboratory markers and radiographic findings in the setting of spinal infections can be nonspecific in determining the presence or absence of active infection, and can lag behind both clinical symptoms and antibiotic response. Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) has been shown to be helpful in evaluating brain abscesses but has not been commonly used in evaluating spinal infections. We aimed to correlate findings on DWI of the spine to results of microbiological sampling in patients with suspected spinal infections.
Methods:
Patients who underwent MRI with DWI for suspicion of spinal infections and microbiological sampling from 2002 to 2010 were identified and reviewed retrospectively in this institutional review board approved study. In addition to DWI, scans included sagittal and axial T1, fast-spin echo (FSE) T2, and post-gadolinium T1 with fat saturation. Regions of interest were drawn on apparent diffusion coefficient (ADC) maps in the area of suspected infections, and ADC values were correlated with microbiological sampling.
Results:
Of 38 patients with suspected spinal infections, 29 (76%) had positive microbiological sampling, and 9 (24%) had negative results. The median ADC value was 740 × 10-6 mm2/s for patients with positive microbiological sampling and 1980 × 10-6 mm2/s for patients with negative microbiological sampling (p < 0.001). Using an ADC value of 1250 × 10-6 mm2/s or less as the cut-off value for a positive result for spinal infection, sensitivity was 66%, specificity was 88%, positive predictive value was 95%, negative predictive value was 41% and accuracy was 70%.
Conclusion:
In patients with suspected spine infection, ADC values on DWI are significantly reduced in those patients with positive microbiological sampling compared to patients with negative microbiological sampling. The DWI of the spine correlates well with the presence or absence of spinal infection and may complement conventional magnetic resonance imaging (MRI).
Insights
Diffusion-weighted imaging (DWI) of the spine shows reduced apparent diffusion coefficient (ADC) values in active spinal infections. This technique correlates well with microbiological sampling, aiding in diagnosing spine infections.
Area of Science:
- Radiology
- Infectious Diseases
- Orthopedic Surgery
Background:
- Laboratory markers and radiographic findings for spinal infections are often nonspecific.
- These markers can lag behind clinical symptoms and antibiotic treatment response.
- Diffusion-weighted imaging (DWI), effective for brain abscesses, is underutilized for spinal infections.
Purpose of the Study:
- To correlate findings on spinal DWI with microbiological sampling results.
- To evaluate the utility of DWI in diagnosing active spinal infections.
- To compare DWI findings with conventional MRI sequences.
Main Methods:
- Retrospective review of patients undergoing MRI with DWI for suspected spinal infections and microbiological sampling (2002-2010).
- Scans included DWI, T1, T2, and post-gadolinium T1 with fat saturation.
- Apparent diffusion coefficient (ADC) values were measured and correlated with microbiological results.
Main Results:
- Of 38 patients, 29 (76%) had positive microbiological sampling.
- Median ADC values were significantly lower in patients with positive (740 × 10⁻⁶ mm²/s) versus negative (1980 × 10⁻⁶ mm²/s) sampling (p < 0.001).
- An ADC cutoff of 1250 × 10⁻⁶ mm²/s yielded 66% sensitivity, 88% specificity, and 70% accuracy.
Conclusions:
- Spinal DWI reveals significantly reduced ADC values in patients with confirmed spinal infections.
- DWI of the spine demonstrates good correlation with microbiological findings.
- Spinal DWI can be a valuable adjunct to conventional MRI for diagnosing spinal infections.
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