Advanced

AJNR - American Journal of Neuroradiology

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

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Hsu, C.Y. Articles by Shih, T.T.F. Search for Related Content PubMed PubMed Citation Articles by Hsu, C.Y. Articles by Shih, T.T.F.

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

View larger version (101K): [in this window] [in a new window]   Fig 1. A 42-year-old man experienced low-back pain and fever for 5 days. A and B, Axial T1-weighted (TR/TE, 600/16) (A) and axial T2-weighted (TR/TE, 4900/111) (B) MR images show an intraosseous lesion of T1-weighted low signal intensity and T2-weighted high signal intensity with an inner rim sign and an outer halo sign (arrow) near the upper endplate of S1. Note the limited amount of epidural soft-tissue inflammation (arrowhead).

View larger version (97K): [in this window] [in a new window]   Fig 2. A 46-year-old woman with fever for 2 days. A and B, Sagittal T1-weighted (TR/TE, 550/12) (A) and sagittal STIR (TR/TE/TI, 3130/65/160) (B) MR images show multiple intraosseous lesions of T1-weighted low signal intensity and STIR high signal intensity. Note some osseous lesions with a positive halo sign (arrows) and the absence of paraspinal or epidural inflammatory soft tissue. C, Sagittal T1-weighted (TR/TE, 550/12) follow-up MR image obtained 12 months later shows gradually reconstituted fatty marrow with a decrease in the number and extent of infectious foci. Note a peripheral rim of increased signal intensity (arrow) in a residual subchondral lesion of low signal intensity at the lower endplate of L5.

View larger version (134K): [in this window] [in a new window]   Fig 3. A 56-year-old man with fever for 1 week. A, Sagittal T1-weighted (TR/TE, 550/12) MR image shows multiple intraosseous lesions of low signal intensity involving the bodies and posterior elements of the vertebrae superimposed on the diffuse abnormal-signal-intensity marrow. Note an osseous lesion with a positive rim sign (arrow) at the T11 vertebra. B, Sagittal T1-weighted (TR/TE, 700/12) fat-suppressed contrast-enhanced MR image reveals global enhancement of intraosseous lesions (arrows). Note the absence of paraspinal or epidural inflammatory soft tissue. C, Sagittal T1-weighted (TR/TE, 700/12) fat-suppressed contrast-enhanced follow-up MR image obtained 5 months later shows an increase in extent, signal-intensity abnormality, and enhancement of T11, L1, L3, and apparently new L4 lesions (arrows) as well as a decrease in the extent of the L2 lesion (arrowhead). D, Sagittal T1-weighted (TR/TE, 700/12) follow-up MR image obtained 25 months later reveals almost complete reconstitution of fatty marrow in previously affected bone.