Abstract
We reviewed serial MRI with and without gadolinium-DTPA in eight patients with spinal epidural abscess and correlated the findings and the clinical manifestations. In four patients, diffuse abscesses spanned four vertebral bodies or more; the others had focal abscesses associated with osteomyelitis and/or diskitis. In three of the four patients with diffuse abscesses, MRI (NCMRI) showed diffuse encasement of the subarachnoid space. Contrast-enhanced MRI (CEMRI) demonstrated linear enhancement surrounding unenhanced pus. In the four patients with focal abscesses, CEMR delineated the inflammatory process more clearly than NCMR. On follow-up studies, decrease in abscess size and better visualization of the subarachnoid space correlated with clinical improvement in both diffuse and focal abscesses. Despite clinical improvement, contrast enhancement persisted in the disk or epidural space of three patients, and was thought to represent chronic granulomatous change or postsurgical scar. CEMR is very valvable for the initial diagnosis of an epidural abscess, particularly if it involves lengthy segments. During follow-up, CEMR can document responses to therapy, and provide information for determining appropriate treatment.
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References
Baker AS, Ojeman RG, Swartz MN, Richardson EP Jr (1975) Spinal epidural abscess. N Engl J Med 293:463–468
Heusner AP (1948) Non-tuberculous spinal epidural infection. N Engl J Med 239:845–854
Verner ER, Musher DM (1985) Spinal epidural abscess. Med Clin North Am 69:375–384
Feldenzer JA, McKeever PE, Schaberg DR, Campbell JA, Hoff JT (1988) The pathogenesis of spinal epidural abscess: microangiographic studies in an experimental model. J Neurosurg 69: 110–114
Lasker BR, Haster DH (1987) Cervical epidural abscess. Neurology 37:1747–1753
Post MJD, Quencer RM, Montalvo BM, Katz BH, Eismont FJ, Green BA (1988) Spinal infection: evaluation with MR imaging and intraoperative US. Radiology 169:765–771
Angtuaco EJC, McConnell JR, Chadduck WM, Flanigan S (1987) MR imaging of spinal epidural sepsis. AJNR 8:879–883
Bydder GM (1988) Clinical applications of gadolinium-DTPA. In: Stark DD, Bradley WG Jr, eds. Magnetic resonance imaging. Mosby, St Louis, pp 182–200
Post MJD, Quencer RM, Eismont FJ, Green BA (1990) Gadolinium-enhanced MR in spinal infection. J Comput Assist Tomogr 14:721–729
Kaufman DM, Kaplan JG, Litman N (1980) Infectious agents in spinal epidural abscess. Neurology 30:844–850
Enzmann DR (1990) Infection and inflammation. In: Enzmann DR, DeLaPaz RL, Rubin JB, eds. Magnetic resonance of the spine. Mosby, St Louis, pp 260–300
Masaryk TJ, Modic MT (1988) Lumbar spine. In: Stark DD, Bradley WG Jr, eds. Magnetic resonance imaging. Mosby, St Louis, pp 666–682
Chang KH, Han MH, Roh JK, Kim IO, Han MC, Kim CW (1990) Gd-DTPA-enhanced MR imaging of the brain in patients with meningitis: comparison with CT. AJNR 11:69–76
Chang KH, Han MH, Choi YW, Kim IO, Han MC, Kim CW (1989) Tuberculous arachnoiditis of the spine: findings on myelography, CT and MR imaging. AJNR 10:1255–1262
Mathews VP, Kuharik MA, Edwards MK, D'Armour PG, Azszarelli B, Dreesen RG (1988) Gd-DTPA-enhanced MR imaging of experimental bacterial meningitis: evaluation and comparison with CT. AJNR 9:1045–1050
Whelan MA, Hilal SK (1980) Computed tomography as a guide in the diagnosis and follow-up of brain abscesses. Radiology 135: 663–671
Feely MP, Dempsey PJ (1979) Assessment of the postoperative course of excised brain abscess by computerized tomography. Neurosurgery 5:49–52
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Sadato, N., Numaguchi, Y., Rigamonti, D. et al. Spinal epidural abscess with gadolinium-enhanced MRI: serial follow-up studies and clinical correlations. Neuroradiology 36, 44–48 (1994). https://doi.org/10.1007/BF00599195
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DOI: https://doi.org/10.1007/BF00599195