Spinal infection: evaluation with MR imaging and intraoperative US

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.