MR Imaging Assessment of the Spine: Infection or an Imitation?

Abstract

Magnetic resonance (MR) imaging is a powerful diagnostic tool that can be used to help evaluate spinal infection and to help distinguish between an infection and other clinical conditions. In most cases of spinal infection, MR images show typical findings such as vertebral endplate destruction, bone marrow and disk signal abnormalities, and paravertebral or epidural abscesses. However, it is not always easy to diagnose a spinal infection, particularly when some of the classic MR imaging features are absent or when there are unusual patterns of infectious spondylitis. Furthermore, noninfectious inflammatory diseases and degenerative disease may simulate spinal infection. It is necessary to be familiar with atypical MR imaging findings of spinal infection and features that may mimic spinal infection to avoid misdiagnosis and inappropriate treatment.

MRI Findings on Iatrogenic Spinal Infection Following Various Pain Management Procedures

“…Such frequency was similar to that of tuberculous spondylitis reported previously (10,25,26). None of our patients showed skip lesions.…”

“…Early diagnosis is essential to the preven- is obvious inflammations in most of the bodies of two adjacent vertebrae and the intervening intervertebral disc. In our cases, the mean number of osteomyelitic vertebral bodies was 1.67, which was less than the 2.3-3 in community-acquired pyogenic spondylitis or tuberculous spondylitis (10,25). Disc destruction was noted in 66.7% of our patients, which was less frequent than previously reported.…”

“…Six of our patients did not show involvement of two adjacent vertebrae or the intervening intervertebral disc. In contrast to community-acquired pyogenic spondylitis, involvement of vertebral bodies and intervertebral disc was relatively weak or faint, but with larger epidural or paravertebral abscesses and extensive myositis in the dorsal and ventral paravertebral spaces similar to tuberculous spondylitis (10,25,26). Epidural abscess was noted in 88.9% of our patients, which was significantly more frequent than what was usually observed in community-acquired pyogenic spondylitis (27,28).…”

SAPHO Syndrome: Imaging Findings of Vertebral Involvement

“…[5][6][7][8][9][10] These advanced imaging findings are often misinterpreted as discitis/ osteomyelitis or metastases. 11,12 In our experience, this misinter-pretation can lead to unnecessary biopsies, other invasive procedures, and, ultimately, delayed diagnosis.…”

Diagnosis of Spondylodiscitis with 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scan in a Patient with Bacteriemia

“…Back pain is the most frequent symptom, affecting the lumbar region in 75% of cases. MRI is a powerful diagnostic tool that can be used to help evaluate spinal infection and help distinguish between an infection, the extension and local effects and other clinical conditions [2]. FDG PET/CT is an emerging tool for the diagnosis of infective endocarditis, as FDG accumulates in areas of increased glucose metabolism, such as inflammatory tissues.…”