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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 26:991-995, May 2005
© 2005 American Society of Neuroradiology

SPINE

Spinal MR Findings in Continuous Epidural Analgesia without Infection

Ichiro Ikushima^a, Toshinori Hirai^c, Yukunori Korogi^d, Maeda Norio^c, Mikako Koganemaru^b, Ryoko Suga^b, Shoji Morishita^c and Yasuyuki Yamashita^c

^a Department of Radiology, Miyakonojo Medical Association Hospital, Kitakyushu, Japan
^b Department of Anesthesiology, Miyakonojo Medical Association Hospital, Kitakyushu, Japan
^c Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kitakyushu, Japan
^d Department of Radiology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan

Address reprint requests to Toshinori Hirai, MD, Department of Diagnostic Radiology, Graduate School of Medical Sciences, School of Medicine, Kumamoto University, 1–1-1 Honjo, Kumamoto 860-8556 Japan

BACKGROUND AND PURPOSE: Spinal epidural abscesses are major complications of epidural anesthesia, and their MR features have been reported. In patients receiving continuous infusion via an epidural catheter, MR findings may mimic those of spinal epidural abscess in the absence of infection. The purpose of this study was to assess the spinal MR findings associated with continuous epidural anesthesia.

METHODS: Spinal MR findings in five consecutive patients receiving continuous epidural anesthesia were retrospectively evaluated. Axial and sagittal T1- and T2-weighted spin-echo and contrast-enhanced fat-suppressed T1-weighted spin-echo images were obtained. Infection was ruled out on microbiologic analysis three patients and on follow-up in two. Each lesion was evaluated for its MR signal intensity, location, extent, delineation, and enhancement pattern. In three patients, follow-up MR imaging was performed within 5–150 days, and the images were compared.

RESULTS: Posterior epidural lesions were identified in all five patients. The lesions were isointense to hypointense relative to the spinal cord on T1-weighted images, isointense relative to CSF on T2-weighted images, and well enhanced on enhanced T1-weighted images. The anomalous enhancement involved two to seven vertebral bodies. In one patient, the enhanced lesion slightly compressed the spinal cord. On follow-up MR imaging, the epidural lesions decreased in two patients and did not change in one.

CONCLUSION: Continuous epidural anesthesia can result in MR findings similar to those of epidural abscess, even in the absence of infection.

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