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Abstract
Purpose:
To prevent permanent neurologic deficit and/or spinal deformity in pyogenic spondylitis early diagnosis and prompt treatment are essential. The purpose of this study is to determine the MR imaging findings of pyogenic spondylitis.
Materials and Methods:
In 31 patients with pathologically or clinically proven pyogenic spondylitis, MR images(31, Tl-weighted å 30, Τ2-weighted å 31, Gd-enhanced Tl-weighted) were retrospectively analyzed. Analysis focused on the signal intensity and enhancement pattern of involved vertebral bodies and intervertebral discs, as well as paravertebral soft tissue abnormality.
Results:
A total of 77 vertebral bodies (mean, 2.5 per patient) were involved. Signal intensity was low in 58 of 77 Tl-weighted images, high in 63 of 75 Τ2-weighted images and in 72 of 77 contrast-enhanced Tl-weighted images, enhancement was diffuse. A total of 47 intervertebral discs were involved. Signal intensity was low or intermediate in all 47 Tl-weighted images, and high or intermediate in 38/46 T2-weighted images å in 24 of 38 contrast-enhanced Tl-weighted images, signal intensity was peripheral, and in 14, enhancement was diffuse. Twenty-six patients showed diffusely enhanced paravertebral soft tissue abnormality and in 14, the largest diameter was less than 1 cm.
Conclusion:
With regard to vertebral bodies, MR imaging findings of pyogenic spondylitis are low signal intensity on Tl-weighted images, and high or intermediate signal intensity on T2-weighted images, together with diffuse enhancement. For intervertebral discs, signal intensity was low on Tl-weighted images, high on T2-weighted images, and peripheral or diffuse enhancement was seen. Diffusely enhanced small paravertebral soft tissue abnormality was also present.
REFERENCES
1.Thrush A., Enzmann D. MR imaging of infectious spondylitis. AJNR. 1990. 11:1171–1180.
2.Smith AS., Blaser SI. Infection and inflammatory processes of the spine. Radiol Clin North Am. 1991. 29:809–827.
3.Sharif HS. Role of MR imaging in the management of spinal infection. AJR. 1992. 158:1333–1345.
4.Mo die MT., Feiglin DH., Piraino DW, et al. Vertebral osteomyelitis: Assessment using MR. Radiology. 1985. 157:157–166.
5.David R., Barron ΒJ., Madewell JE. Osteomyelitis, acute and chronic. Radiol Clin North Am. 1987. 25:1171–1201.
6.Post MJD., Sze G., Quencer RM., Eismost FJ., Green ΒA., Gahbauer H. Gadolinium enhanced MR in spinal infection. J Comput Assist Tomogr. 1990. 14:721–729.
7.Smith AS., Weinstein MA., Mizushima A, et al. MR imaging characteristics of tuberculous spondylitis vs vertebral osteomyelitis. AJR. 1989. 153:399–405.
8.Sharif HS., Clark DC., Aabed MY, et al. Granulomatous spinal infection: MR imaing. Radiology. 1990. 177:101–107.
9.Modic MT., Masaryk TJ., Ross JS., Carter JR. Imaging of degenerative disc disease. Radiology. 1988. 177–186.
10.de Roos A., Kressel H., Spritzer C., Dalinka M. MR imaging of marrow changes adjacent to endplates in degenerative lumbar disk disease. AJR. 1987. 149:531–534.
11.Dagirmanjian A., Schils J., McHenry M., Modic MT. MR imaging of vertebral osteomyelitis revisited. AJR. 1996. 167:1539–1543.
12.강홍식, 연경모. 결핵성과화농성척추염의감별: 척추주위종괴의자기공명영상특성. 대한방사선의학희지. 1996. 34:825–830.
13.Whelan MA., Naidich DP., Post JD, et al. Computed tomography of spinal tuberculosis. J Comput Assist Tomogr. 1983. 7:25–30.
14.박동우, 이채국. 척추질환의이엽성전방경막외파급: 자기공명영상소견. 대한방사선의학희지. 1994. 31:955–959.
15.홍명선, 이길우, 강익원, 윤구섭, 최철순, 배상훈. 척추전이암과척추결핵의자기공명영상소견비교. 대한방사선의학희지. 1996. 31:743–74.
Fig. 1.
38-year-old woman with pyogenic spondylitis who had back pain for 1 month. A. Tl-weighted sagittal image shows decreased signal intensity in the T10 and Til vertebral bodies with focal disruption of the endplate(arrow). Intervening disc shows decrease in its height and signal intensity. B. T2-weighted sagittal image shows increased signal intensity in the same level of the vertebral bodies and the intervertebral disc with abscence of a nuclear cleft. C. Gadolinium enhanced Tl-weighted sagittal image shows diffuse enhancement of involving vertebral bodies and subtle enhancement of intervening disc. D. Gadolinium enhanced Tl-weighted axial image shows diffuse enhancement of the paravertebral soft tissue (white arrows) with focal disruption at the anterior cortical margin of T10 (black arrow).
Fig. 2.
50-year-old man with pyogenic spondylitis who had back pain for 3 years. A. Tl-weighted sagittal image shows increased signal intensity in the Til to L4 vertebral bodies. These vertebral bodies are fused partially due to previous operation(arrow heads). Intervening discs show decrease in their height and signal intensity(arrow). B. T2-weighted sagittal image shows persistently increased signal intensity in the same level of the vertebral bodies and high signal intensity of T12-L1 and Ll-2 intervertebral discs. C. Gadolinium enhanced Tl-weighted sagittal image dose not show obvious enhancement involving vertebral bodies. But some intervertebral discs (T12-L1, Ll-2) are enhanced peripherally(arrow).
Fig. 3.
21-year-old man with staphylococcal spondylitis who had back pain for 1 month. A. Tl-weighted sagittal image shows decreased signal intensity in the L4 and L5 vertebral bodies(open arrows). Intervening disc shows diffuse low signal intensity(arrow). B. T2-weighted sagittal image shows persistent low signal intensity in the L4 and L5 vertebral bodies(open arrows). But the intervening disc shows high signal intensity with abscence of a nuclear cleft(arrow). C. Gadolinium enhanced Tl-weighted sagittal image shows diffuse enhancement of involving vertebral bodies (open arrows) and peripheral enhancement of intervening disc(arrow).
Fig. 4.
23-year-old man with pyogenic spondylitis who had back pain for 2 months. A. Tl-weighted sagittal image shows decreased signal intensity in the L3, L4 and, L5 vertebral bodies with focal disruption of the endplates(black arrows). Intervening discs show decreased signal intensity(white arrows). B. T2-weighted sagittal image shows increased signal intensity in the same level of the vertebral bodies but inhomogenous low signal intensity of the intervening discs with abscence of a nuclear clefts(arrows). C. Gadolinium enhanced Tl-weighted sagittal image shows diffuse enhancement of involving vertebral bodies and peripheral enhancement of intervening discs(arrows).
Table 1.
Signal Intensity of Involved Vertebrae and Intervertebral Discs.
| Vertebrae | Disc | |||
|---|---|---|---|---|
| T1WI (n=77) | T2WI (n = 75) | T1WI (n=47) | T2WI (n=46) | |
| Low SI | 58 | 2 | 34 | 8 |
| Intermediate SI | 8 | 10 | 13 | 13 |
| High SI | 11 | 63 | — | 25 |
Table 2.
Enhancernent Pattern of Vertebrae, Discs, and Soft Tissue Masses.
| Vertebrae (n=77) | Discs (n=38) | Soft tissue masses (n=26) | |
|---|---|---|---|
| Diffuse | 72 | 14 | 21 |
| Peripheral | 5 | 24 | 5 |
1998 년도 대한방사선의학회 춘계전공의연수교육 Ꮊ 4 내
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