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Spinal osteomyelitis: unusual findings on magnetic resonance imaging

A S Michael1, M A Mikhael

  • 1Department of Diagnostic Radiology, Evanston Hospital, IL 60201.

Insights

Intact vertebral end plates do not rule out vertebral osteomyelitis on MRI. This finding is crucial for differentiating spinal infections from metastatic disease.

Area of Science:

  • Radiology
  • Infectious Diseases
  • Spinal Imaging

Background:

  • Bacterial spinal infections typically involve intervertebral discs and vertebral bodies.
  • Common MRI findings include disc narrowing and irregular vertebral end plates.

Observation:

  • A case presented with MR imaging showing intact vertebral end plates.
  • Despite intact end plates, adjacent vertebral bodies and the disc were infected with anaerobic streptococcus.
  • Extensive infection led to paravertebral inflammatory masses.

Findings:

  • Intact vertebral end plates can be present in cases of vertebral osteomyelitis.
  • This challenges the assumption that end plate integrity excludes infection.

Implications:

  • MR imaging findings of intact vertebral end plates do not exclude vertebral osteomyelitis.
  • Radiologists must consider infection even with seemingly normal end plates, differentiating it from metastatic disease.

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