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AJNR - American Journal of Neuroradiology

Published ahead of print on March 20, 2008
doi: 10.3174/ajnr.A1003

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American Journal of Neuroradiology 29:1104-1110, June-July 2008
© 2008 American Society of Neuroradiology

SPINE

Unusual Manifestations of Vertebral Osteomyelitis: Intraosseous Lesions Mimicking Metastases

C.Y. Hsu^a, C.W. Yu^a, M.Z. Wu^b, B.B. Chen^a, K.M. Huang^a,c and T.T.F. Shih^a

^a Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
^b Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
^c Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Please address correspondence to Tiffany Ting-Fang Shih, MD, Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan S Rd, Taipei, Taiwan 100; e-mail: ttfshih{at}ntu.edu.tw

BACKGROUND AND PURPOSE: Vertebral osteomyelitis can have different imaging manifestations. The purpose of this study was to demonstrate the unusual MR imaging patterns of vertebral osteomyelitis with intraosseous lesions mimicking metastases.

MATERIALS AND METHODS: From September 2000 to August 2007, 7 patients were selected from our data base of 214 patients with confirmed vertebral osteomyelitis and MR images. All of those having misinterpreted MR imaging reports and unusual imaging patterns were analyzed. The presence of a peripheral curvilinear area of low signal intensity in an osseous lesion (the rim sign) and a peripheral rim of high signal intensity on T2-weighted images around an osseous lesion (the halo sign) was evaluated. Follow-up MR imaging studies were performed in all patients.

RESULTS: The patients were 5 men and 2 women, with an age range of 42–80 years. MR imaging findings of those with vertebral osteomyelitis showed a solitary lesion in 2 and multiple lesions in 5 patients. The intraosseous lesions revealed low signal intensity on T1-weighted images, mixed or high signal intensity on T2-weighted images, high signal intensity on short inversion recovery images, and global or marginal enhancement. The rim sign was found in 6 (86%) patients; halo sign, in 7 (100%); preserved intervertebral disks, in 7 (100%); and limited paraspinal or epidural inflammation, in 6 (86%). Images of all patients demonstrated healing or almost healed changes on the follow-up MR imaging studies.

CONCLUSION: Vertebral osteomyelitis can have MR imaging patterns mimicking osseous metastases. Recognition of these unusual imaging manifestations, together with clinical and histopathologic analysis, may aid in reaching the correct diagnosis.