Morphological Aspect of Pyogenic Spinal Epidural Abscesses. Part I

Abstract

Background: Pyogenic Spinal Epidural Abscess (PSEA) is difficult to diagnose and can have devastating consequences. Magnetic Resonance Imaging (MRI) has high sensitivity and specificity, which are further increased with the use of contrast. There are several classifications of vertebral infectious processes, with emphasis on spondylodiscitis. Objective: To analyze the morphological parameters and their reproducibility; and to analyze different resonance imaging sequences. Methods: Using an image database, a morphological classification of PSEA was planned, with five parameters: Region (R), indicating the upper and lower limits of the abscess; Location (U), indicating whether the abscess is anterior or posterior within the canal; Compromise (C), meningeal or content of the structures; Association (A), discitis, osteomyelitis or both; and Perivertebral (P), anterior, lateral or posterior extravertebral abscess. The first three parameters give an idea of the volume of the PSEA, while the last two give the related infectious foci. Thirty-five cases were analyzed using Kappa’s coefficient. Results: The global intra- and interobserver reproducibility was Kappa 0.81. The results for each parameter were as follows: R=0.95, U=0.92, C=0.66, A=0.70 and P=0.80. The first three give a notion of volume and the last two relate to the presence of vertebral infectious foci outside the canal. T2 weighted MRI with contrast was found to be the most effective imaging sequence. Conclusion: The morphological classification is simple to use, with excellent reproducibility. The parameters with the highest reproducibility were region and location, with values >0.92. The addition of gadolinium contrast increased the sensitivity of the diagnosis; the use of sagittal and axial images in T2-MRI was the most sensitive imaging sequence. Evidence Level III; Original.

Aspectos morfológicos del absceso epidural espinal piógeno

“…En la primera parte de este proceso, 18 el coeficiente kappa de Cohen, sobre reproducibilidad intra-e interobservador global fue de 0,81, un valor excelente de reproducibilidad; los restantes valores fueron: R 0,95; U 0,92; C 0,66 según la ventana de la resonancia y el uso de medio de contraste; A 0,70 y P 0,80, sensiblemente superior al resultado de esta evaluación, creemos que se debe a que, en la primera experiencia, participaron ortopedistas dedicados exclusivamente a patología espinal. Desde aquí formulamos que nuestra propuesta de clasificación morfológica describe e incorpora aspectos referidos a la longitud, la ubicación, el tipo de compresión y su asociación al cuerpo vertebral, al disco intervertebral, paravertebral, y a infecciones alejadas, con excelente reproducibilidad inter-e intraobservador.…”