Reliability of diffusion weighted MR imaging in differentiating degenerative and infectious end plate changes

Abstract

BackgroundThe aim of the study was to investigate the value of diffusion weighted MR imaging in the diagnosis of Modic type 1 change, which may be confused with the acute infectious spondylodiscitis on conventional MR imaging.Patients and methodsTwenty-seven patients with erosive intervertebral osteochondrosis, Modic type 1 and 18 patients with spondylodiscitis were included in this retrospective study. All images were acquired using on 1.5 Tesla MR units. Lumbar spinal MR imaging of 45 patients were retrieved from a digital database of a radiology record system and evaluated by one experienced radiologist. Patients with Modic type 1 change had CT slices obtained from the diseased disc space and the affected vertebrae.ResultsBone marrow adjacent to the vertebral end plate in both Modic type 1 change and acute spondylodiscitis were hypointense on T1-weighted images. On T2-weighted images corresponding levels of vertebral end-plates showed hyperintense signal intensity in both group. All the patients with spondylodiscitis and Modic type 1 change were hyperintense and hypointense on diffusion-weighted MR images, respectively.ConclusionsOur findings suggest that diffusion weighted MR imaging is an useful method in differentiating Modic type 1 changes from acute spondylodiscitis, both of which may mimic each other, either on clinical or conventional MRI findings.

Magnetic Resonance Imaging Findings of Early Spondylodiscitis: Interpretive Challenges and Atypical Findings

“…In particular, they include bone marrow edema visualized as high signal intensity on T2WI (3839). These bone marrow changes may also be enhanced on contrast-enhanced images.…”

“…9), and degenerative or reactive bone changes related to disc degeneration cannot always be confidently distinguished from infection by imaging. Clinical and laboratory findings, such as white blood cell count, ESR, and elevated body temperature, provide supportive but not confirmatory evidence of infectious spondylodiscitis (3852). Accordingly, when the clinical impression, laboratory findings, and imaging do not allow the exclusion of infection, a biopsy should be performed (1).…”

Diffusion-Weighted MRI "Claw Sign" Improves Differentiation of Infectious from Degenerative Modic Type 1 Signal Changes of the Spine

“…[3][4][5][6][7][8][9][10][11][12][13] Modic type 1 degenerative signal changes on conventional MR imaging sequences can mimic or suggest infection, leading to additional costly and sometimes invasive investigations. [14][15][16][17] This study assesses the utility of a specific pattern of diffusion abnormality, the "claw sign," for confirming the presence of true degenerative endplate changes and reducing concern for possible vertebral diskitis/osteomyelitis.…”

Diffusion differences between pilocytic astrocytomas and grade II ependymomas

“…This method is currently available on virtually all MRI scanners; it is non-invasive, with short acquisition times and is free from motion artefacts compared to other imaging sequences. It is widely used in diagnostics of stroke, as well as other pathological conditions 7,8. Differentiation of intracranial tumours on the basis of their ADC values has been relatively extensively studied, however, with disparate results 9–16…”