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Fungal Spinal Osteomyelitis in the Immunocompromised Patient: MR Findings in Three Cases

Robert L. WilliamsGo,a, Melanie B. Fukuia, Carolyn Cidis Meltzera, Amar Swarnkara, David W. Johnsona and William Welcha

a From the Departments of Radiology (R.L.W., M.B.F., C.C.M., A.S., D.W.J.), Psychiatry (C.C.M.), and Neurological Surgery (W.W.), University of Pittsburgh Medical Center.



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  		FIG 1. Case 1: 49-year-old man with Candida albicans infection. Biopsy was performed of the L2–L3 disk and L3 vertebra.

A, Sagittal T1-weighted (416/19/2 [TR/TE/excitations]) spin-echo image in the midline of the lumbar spine shows minimal hypointensity within the L2, L3, and L4 vertebral bodies (arrows).

B, Corresponding contrast-enhanced sagittal T1-weighted (749/11/2) image shows enhancement of the vertebral bodies and endplates (arrows).

C, Sagittal T2-weighted (3000/102/4) fast spin-echo image with fat saturation shows minimal hyperintensity within the vertebral endplates at the L2, L3, and L4 levels. Isointense signal with preserved intranuclear clefts (arrows) is present in the L2–L3 and L3–L4 disks as compared with the minimally degenerated disks at the L4–L5 and L5–S1 levels.

D, Sagittal T1-weighted (533/11/2) image 10 days after the initial study shows increased hypointense signal in the L2, L3, and L4 vertebral bodies (arrows).

E, Corresponding sagittal T2-weighted (2600/102/2) fast spin-echo image with fat saturation shows only minimally increased hyperintense signal hyperintense signal in the L2, L3, and L4 vertebral bodies (arrows).



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  		FIG 2. Case 2: 51-year-old man with Candida albicans osteomyelitis. Biopsy was performed at the T12 vertebral body.

A, Sagittal T1-weighted (500/10/2) image of the lower thoracic and lumbar spine shows hypointense signal within the T12 and L1 vertebral bodies (arrows).

B, Contrast enhanced T1-weighted (633/10/2) image shows enhancement of the vertebral marrow producing isointense to hyperintense signal (arrows).

C, Corresponding T2-weighted (4000/102/2) fast spin-echo image shows the normal signal and intranuclear cleft of the T12–L1 disk (arrow).



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  		FIG 3. Case 3: 54-year-old woman with Aspergillus osteomyelitis. Biopsy was performed of the L2–L3 paraspinal inflammation and the L3 vertebra.

A, Sagittal T1-weighted (666/15/2) image of the lumbar spine shows multilevel disease with hypointensity in the L2, L3, vertebrae and superior endplate of L4 (arrows). Paraspinal and epidural disease is also present.

B and C, Sagittal and parasagittal contrast-enhanced T1-weighted (616/10/2) images show enhancing paraspinal and epidural inflammation. Disease also extends into the pedicles.

D and E, Sagittal T2-weighted (3500/102/2) fast spin-echo images with (D) and without (E) fat-saturation technique show hyperintense signal within the L2, L3, and L4 vertebrae and superior endplate of L4. Note the increased conspicuity of signal change with fat-saturation. In addition, the L3–L4 disk is normal in signal with a preserved intranuclear cleft. The L2–L3 disk is collapsed.

F, Axial T1-weighted (500/18/1.5) spin-echo image at the L3 level depicts epidural and paraspinal inflammation (arrows).





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X