Resolution of an Aggressive Ideopathic Diskitis
Alice B. Smitha,
Arthur G. Kanea,d,
Anne H. Sholesb and
Judy H. Freemanc
a Department of Radiology, Tripler Army Medical Center, Honolulu, HI
b Department of Neurosurgery, Tripler Army Medical Center, Honolulu, HI
c Department of Pathology, Tripler Army Medical Center, Honolulu, HI
d Uniform Services University of the Health Sciences, Bethesda, MD
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FIG 1. Initial CT and MR images two weeks after the abnormal bone scan as part of work-up for two months of progressive thoracic pain.
A, Initial coronal T1-weighted postgadolinium image with fat saturation demonstrates contiguous intense enhancement of the intervertebral disk, endplate, and adjacent marrow (open arrow), with less intense enhancement of the T8 and T9 vertebral bodies and paraspinous region (arrows).
B, Initial sagittal Fast Spin-Echo T2-weighted and fat-nulled Inversion Recovery (FSEIR) image demonstrates increased signal intensity in the T8 and T9 vertebral bodies and the intervertebral disk (arrow).
C and D, CT coronal (C) and sagittal (D) reconstructions reveal destruction of endplates and adjacent cancelous bone (arrow).
E, Core biopsy needle (arrow) traverses central endplate erosion (arrowhead).
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FIG 2. Follow-up MR images obtained 5 months later.
A, Sagittal FSEIR findings are normal, with restoration of intact T8–T9 endplates (arrow) and normal T8 and T9 marrow signal intensity.
B, T1 precontrast image (arrow) shows residual decrease in marrow signal intensity.
C, Postgadolinium fat-saturated sagittal image demonstrates complete resolution of enhancement of the T8 and T9 vertebral bodies and paraspinous tissues and minimal residual enhancement of the T8–T9 intervertebral disk.
D, At 9 months, a Schmorl’s node is evident along the superior T9 endplate (arrow), larger than those present at the level above (arrowheads), which were present on the initial image. (Note in Fig 2D the paraspinous soft tissue swelling and enhancement is gone, compared with Fig 1A.)
E, Biopsy at 4 months reveals chronic mononuclear inflammation surrounding fibrovascular tissue (arrows).
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