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Spinal infection: evaluation with MR imaging and intraoperative US
M J Post1, R M Quencer, B M Montalvo
1Department of Radiology, University of Miami School of Medicine, FL 33101.
Abstract:
Magnetic resonance (MR) images of the spine and/or intraoperative spinal ultrasound (US) in 24 patients with spinal infections were reviewed and correlated with clinical and pathologic data to determine their diagnostic value. In disk space infection with osteomyelitis and in retrospinal abscess, MR images showed characteristic findings, whereas in myelitis, MR images demonstrated nonspecific abnormalities. The appearance on MR images of epidural abscesses ranged from clearly identifiable extradural masses with high-intensity signal on spin-echo T2-weighted images to extensive inhomogeneous collections of mixed signal intensities, difficult to distinguish from adjacent meningitis. Myelography with high-resolution computed tomography (CT) and intraoperative spinal US was superior to MR imaging in demonstrating epidural abscesses when there was concomitant meningitis. With intraoperative spinal US, epidural abscesses could be located and their decompression monitored. MR imaging is recommended as the initial screening procedure in spinal infection; in those few patients with nondiagnostic MR images, myelography with high-resolution CT should be the supplementary study. If surgery is planned, intraoperative spinal US should be used.
Insights
Magnetic resonance imaging (MRI) is a valuable initial tool for diagnosing spinal infections. However, for complex cases like epidural abscesses with meningitis, myelography with computed tomography (CT) and intraoperative spinal ultrasound (US) offer superior visualization and guidance.
Area of Science:
- Radiology
- Neurosurgery
- Infectious Diseases
Background:
- Spinal infections pose diagnostic challenges, requiring accurate imaging for timely intervention.
- Differentiating various types of spinal infections, such as osteomyelitis, discitis, and abscesses, is crucial for effective treatment.
Purpose of the Study:
- To evaluate the diagnostic utility of magnetic resonance (MR) imaging and intraoperative spinal ultrasound (US) in patients with spinal infections.
- To compare the effectiveness of MR imaging, myelography with computed tomography (CT), and spinal US in identifying and characterizing spinal infections, particularly epidural abscesses.
Main Methods:
- Retrospective review of MR images and/or intraoperative spinal US in 24 patients with spinal infections.
- Correlation of imaging findings with clinical and pathological data.
- Comparative analysis of diagnostic performance between MR imaging, myelography with CT, and spinal US.
Main Results:
- MR imaging showed characteristic findings in disc space infections with osteomyelitis and retrospinal abscesses but nonspecific abnormalities in myelitis.
- MR imaging of epidural abscesses varied, sometimes being difficult to distinguish from meningitis.
- Myelography with high-resolution CT and intraoperative spinal US were superior to MR imaging in demonstrating epidural abscesses when meningitis was present.
- Intraoperative spinal US effectively located epidural abscesses and monitored decompression.
Conclusions:
- MR imaging is recommended as the initial screening modality for spinal infections.
- For non-diagnostic MR images, myelography with high-resolution CT serves as a valuable supplementary study.
- Intraoperative spinal US is essential for surgical planning and guidance in cases requiring intervention.