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Spinal epidural abscess with gadolinium-enhanced MRI: serial follow-up studies and clinical correlations
N Sadato1, Y Numaguchi, D Rigamonti
1Department of Diagnostic Radiology, University of Maryland Medical System, Baltimore 21201.
Abstract:
We reviewed serial MRI with and without gadolinium-DTPA in eight patients with spinal epidural abscess and correlated the findings and the clinical manifestations. In four patients, diffuse abscesses spanned four vertebral bodies or more; the others had focal abscesses associated with osteomyelitis and/or diskitis. In three of the four patients with diffuse abscesses, MRI (NCMRI) showed diffuse encasement of the subarachnoid space. Contrast-enhanced MRI (CEMRI) demonstrated linear enhancement surrounding unenhanced pus. In the four patients with focal abscesses, CEMR delineated the inflammatory process more clearly than NCMR. On follow-up studies, decrease in abscess size and better visualization of the subarachnoid space correlated with clinical improvement in both diffuse and focal abscesses. Despite clinical improvement, contrast enhancement persisted in the disk or epidural space of three patients, and was thought to represent chronic granulomatous change or postsurgical scar. CEMR is very valuable for the initial diagnosis of an epidural abscess, particularly if it involves lengthy segments. During follow-up, CEMR can document responses to therapy, and provide information for determining appropriate treatment.
Insights
Contrast-enhanced MRI (CEMRI) effectively diagnoses spinal epidural abscesses and monitors treatment response. Follow-up CEMRI shows abscess shrinkage and improved subarachnoid space visualization correlating with clinical improvement.
Area of Science:
- Radiology
- Neuroradiology
- Spinal Imaging
Background:
- Spinal epidural abscesses (SEAs) are serious infections requiring prompt diagnosis and management.
- Magnetic Resonance Imaging (MRI) is crucial for evaluating SEAs, but the role of contrast enhancement needs further clarification.
Purpose of the Study:
- To evaluate the diagnostic and follow-up utility of contrast-enhanced MRI (CEMRI) in patients with spinal epidural abscess.
Main Methods:
- Serial MRI scans with and without gadolinium-DTPA were performed on eight patients with SEA.
- Findings were correlated with clinical manifestations and follow-up assessments.
Main Results:
- CEMRI delineated inflammatory processes more clearly than non-contrast MRI (NCMR), especially in focal abscesses.
- In diffuse abscesses, CEMRI showed linear enhancement surrounding unenhanced pus.
- Abscess size reduction and improved subarachnoid space visualization on follow-up correlated with clinical improvement.
Conclusions:
- CEMRI is highly valuable for initial diagnosis of spinal epidural abscess, particularly extensive ones.
- CEMRI effectively documents treatment response and aids in treatment decisions.
- Persistent enhancement post-treatment may indicate chronic changes rather than active infection.