MR imaging of spinal infection: atypical features, interpretative pitfalls and potential mimickers

Mellado, José María Asencio; Palomar, Laura; Camins, Àngels; Salvadó, E.; Ramos, A.; Saurí, A.

doi:10.1007/s00330-004-2310-8

Cited by 26 publications

(9 citation statements)

References 31 publications

(84 reference statements)

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“…Characteristic imaging findings and isolation of the causative organism are the main tools for the correct diagnosis [1]. Plain radiographs, computed tomography (CT), scintigraphic techniques, and magnetic resonance imaging (MRI) can all be used in the diagnosis [2].…”

Section: Introductionmentioning

confidence: 99%

Spinal infections

Tali

G�ltekin

2004

Eur Radiol

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Spinal infections have an increasing prevalence among the general population. Definitive diagnosis based solely on clinical grounds is usually not possible and radiological imaging is used in almost all patients. The primary aim of the authors is to present an overview of spinal infections located in epidural, intradural and intramedullary compartments and to provide diagnostic clues regarding different imaging modalities, particularly MRI, to the practicing physicians and radiologists.

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Section: Introductionmentioning

confidence: 99%

Spinal infections

Tali

G�ltekin

2004

Eur Radiol

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“…[32][33][34][35] This is another important route of infection resulting in epidural/ paraspinal abscesses. Facet joint infection is often haematogenous but also caused by epidural anaesthesia and spinal procedures.…”

Section: Epidural/paraspinal Abscess With Facet Joint Infectionmentioning

confidence: 99%

Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections

Moritani

Kim²,

Capizzano³

et al. 2014

BJR

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The incidence of spinal infections has increased in the past two decades, owing to the increasing number of elderly patients, immunocompromised conditions, spinal surgery and instrumentation, vascular access and intravenous drug use. Conventional MRI is the gold standard for diagnostic imaging; however, there are still a significant number of misdiagnosed cases. Diffusion-weighted imaging (DWI) with a b-value of 1000 and apparent diffusion coefficient (ADC) maps provide early and accurate detection of abscess and pus collection. Pyogenic infections are classified into four types of extension based on MRI and DWI findings: (1) epidural/paraspinal abscess with spondylodiscitis, (2) epidural/ paraspinal abscess with facet joint infection, (3) epidural/paraspinal abscess without concomitant spondylodiscitis or facet joint infection and (4) intradural abscess (subdural abscess, purulent meningitis and spinal cord abscess). DWI easily detects abscesses and demonstrates the extension, multiplicity and remote disseminated infection. DWI is often a key image in the differential diagnosis. Important differential diagnoses include epidural, subdural or subarachnoid haemorrhage, cerebrospinal fluid leak, disc herniation, synovial cyst, granulation tissue, intra-or extradural tumour and post-surgical fluid collections. DWI and the ADC values are affected by susceptibility artefacts, incomplete fat suppression and volume-averaging artefacts. Recognition of artefacts is essential when interpreting DWI of spinal and paraspinal infections. DWI is not only useful for the diagnosis but also for the treatment planning of pyogenic and nonpyogenic spinal infections.Spinal and paraspinal infections include vertebral osteomyelitis, spondylodiscitis, infectious facet arthropathy, epidural infections, meningitis, myelitis and infections of paraspinal soft tissue and musculature. Evidence of spinal infections has been discovered in the remains of prehistoric humans from 7000 BC. 1 The incidence has increased in the past two decades, owing to the rising number of elderly patients, immunocompromised conditions, spinal surgery and instrumentation, vascular access and intravenous drug use.1-4 Despite advances in medical knowledge, imaging modalities and surgical interventions, the diagnosis of this entity is still challenging since the clinical features can be subtle and misleading. MRI including post-contrast studies is the gold standard for diagnostic imaging. However, although MRI has relatively high diagnostic sensitivity, specificity and accuracy, there are still a significant number of challenging cases. In such cases, diagnostic delays and suboptimal management can result in irreversible paralysis, critical sepsis and even death.Diffusion-weighted imaging (DWI) has proven to be a useful tool for the diagnosis of a variety of intracranial infections especially in the detection of brain abscesses and pus collections, which encompass subdural and epidural empyema, purulent meningitis and ventriculitis. [5][6][7][8] Therefore, DWI ...

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“…The reticulated porous lesions found on the vertebral neural arches could also be evoked as a possible feature for disease discrimination. Destruction on the posterior vertebral elements, through extension of the vertebral body infection, may occur in both pathological processes (Jevtic, 2004;Harada et al, 2008), but the involvement of the pedicle, laminae and spinous process has been reported to occur more often in spinal tuberculosis and less encountered in pyogenic infection (Magnus & Hoffman, 2000;Jinkins, 2002;Mellado et al, 2004;Quiñ ones-Honojosa et al, 2004;Turunc et al, 2007;Harada et al, 2008). The neural arches affection in clinical surveys were observed in 5%, 40% and 61,5% of tuberculous spondylitis patients, respectively by Kumar (1985in Weber et al, 2004, Magnus & Hoffman (2000) and Turunc et al (2007).…”

Section: Infectious Conditionsmentioning

confidence: 99%

“…This has long been pointed out that it has a source of distinction from pyogenic spondylitis. But it must be emphasised that recent clinical studies (Ledermann et al, 2003;Mellado et al, 2004) demonstrated that patients with non-tuberculous bacterial infections presented also 'frank vertebral collapse with resulting gibbus deformity' (Ledermann et al, 2003: p. 513). These studies, along with those above quoted for fungal infections illustrate the need for extreme caution when considering gibbus deformity as the epitome of tuberculosis.…”

Section: Infectious Conditionsmentioning

confidence: 99%

Severe vertebral collapse in a juvenile from the graveyard (13th/14th–19th centuries) of the São Miguel church (Castelo Branco, Portugal): differential palaeopathological diagnosis

Matos

Marques

Lopes

2011

Intl J of Osteoarchaeology

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Diseases that culminate into vertebral collapse are of intricate diagnosis both in palaeopathology and modern clinical practice. When analysing human skeletal remains from the archaeological record this difficulty is amplified due to the absence of complementary medical diagnostic information. This is especially evident when the distinction between tuberculous and pyogenic spondylitis is intended. Taking into consideration this challenging task and based on the macroscopic and radiological study of the skeleton number 8, a specimen exhumed from the East necropolis (13th/14th to 19th centuries) of the Sã o Miguel church, at the Portuguese city of Castelo Branco, the aims of the work here presented are to discuss the range of possible aetiological factors, especially infectious ones, ascribable to the striking pathological changes noticed on this 12-year-old individual. These included alterations on the axial skeleton, namely extensive vertebral destruction, presenting as a gibbus deformity, and correlated thoracic deformities. Consubstantiated on palaeopathological and clinical research, tuberculous spondylitis seems to be the most probable cause for the reported lesions. However, the scrutiny between this condition and other pyogenic spinal infections is of extreme complexity when analysing ancient human remains and deserves in-depth future investigations. Within the framework of the Portuguese archaeological record, the specimen here presented is of major relevance since the pattern and severity of the spinal osseous changes observed were not previously reported. Further, if tuberculous spondylitis is assumed as the most probable diagnosis, the case here presented represents one of the earliest skeletal evidence of this condition in Portugal.

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MR imaging of spinal infection: atypical features, interpretative pitfalls and potential mimickers

Cited by 26 publications

References 31 publications

Spinal infections

Spinal infections

Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections

Severe vertebral collapse in a juvenile from the graveyard (13th/14th–19th centuries) of the São Miguel church (Castelo Branco, Portugal): differential palaeopathological diagnosis

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