Early diagnosis of single segment vertebral osteomyelitis—mr pattern and its characteristics

doi:10.1016/S0899-7071(99)00108-4

Clinical Imaging

Volume 23, Issue 3, May–June 1999, Pages 159-167

https://doi.org/10.1016/S0899-7071(99)00108-4 Get rights and content

Abstract

Nine cases of single segment vertebral osteomyelitis were included based on the single level of vertebral body involvement according to the MR findings. They were 3 cases with tuberculous infection and 6 cases with pyogenic infection. The vertebral body involvement was presented as abnormal signal changes (100%) and heterogenous enhancement (77.7%). They usually caused the cortical disruption in its anterior aspect (100%). It goes along the upward subligamentous spread (100%) most often, then the upper disc involvement (66.6%) and downward subligamentous spread (55.5%). The lower disc involvement is least common (11.1%). By using these criteria, the single segment vertebral osteomyelitis could be earlier diagnosed.

Introduction

The typical MR imaging findings for infectious spondylitis and vertebral osteomyelitis are frequently reported to be decreased signal intensity in the disk and adjacent vertebral bodies on T1-weighted images, increased signal intensity in the disk and adjacent vertebral bodies on T2-weighted images, and loss of endplate definition on T1-weighted images (1). The revised imaging criteria were also mentioned after reviewing a large group of patients diagnosed with vertebral osteomyelitis (2). However, atypical observations of spinal tuberculosis at MR imaging were reported (3). The tuberculosis affected only a single segment vertebral body, single spinous process of lumbarsacral spine without affecting the intervertebral disk spaces. Early diagnosis of spinal tuberculosis by MRI was also mentioned (4); two among seventeen patients had neither an abscess nor disk involvement, but only one vertebral involvement by tuberculosis. For the pyogenic spondylitis, noninvolvement of the intervertebral disk space were observed in two among sixteen patients (5). However, there was no literature that mentioned single segment vertebral involvement caused by a pyogenic microorganism. For the MR findings of single vertebral changes without involving the intervening disk or adjacent vertebra, MR findings are more suggestive of neoplasm than infection. Because we also observed these variants, we were prompted to review our experience. Our intention for this study was to review the MR imaging of nine patients diagnosed as single segment vertebral osteomyelitis in our series from 1992 to 1998 in order to determine the diagnostic criterion and pattern of early spinal infection by MR imaging.

Section snippets

Materials and methods

Medical records were reviewed for all patients with a discharge diagnosis of spinal osteomyelitis from January 1, 1992 to June 30, 1998. One hundred and seven patients had a febril clinical illness with disabling spinal involvement and an established microbiologic diagnosis. All the patients had MR examinations of the spine. The MR images were reviewed retrospectively. Nine patients among them had single-level involvement of the vertebra determined by MR images. The remaining 98 patients had

Results

Nine of the 107 patients diagnosed as spinal osteomyelitis were included and considered as single level of vertebral involvement according to the MR findings. The diagnostic criteria were based on the abnormal signal change observed only in one segment of vertebra by T1WI, T2WI and post-enhanced fat suppression images. The adjacent vertebral bodies did not have abnormal signal changes in any of the sequences. The clinical information of these nine patients is listed in Table 1. There were 7

Discussion

This retrospective study investigated the MR imaging findings for vertebral osteomyelitis involving the single level vertebra (single segment vertebral osteomyelitis). In the previous literature report, single vertebral involvement of tuberculosis has been noted in 12% of cases on conventional radiography by a group of investigators (6). However, conventional radiography detects the bony lesions and cannot detect the early change of bone marrow or soft tissue caused by inflammation. A group of

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Citation Excerpt :
Isointense or increased signal on T1 sequences from the vertebral bodies has also been described in the absence of endplate erosions.20 While pyogenic infection generally involves the adjacent intervertebral disc, infection may be confined to an isolated vertebral body in some cases.30 This may suggest the early stages of infection, but may also represent, uncommonly, a contained chronic infection within the vertebral body.31
Spinal infections can arise in a variety of anatomical locations and structures and encompass vertebral osteomyelitis, discitis, disc space infection, epidural abscesses, and infection of the adjacent soft tissue structures. Plain radiography, computed tomography, magnetic resonance imaging (MRI), and nuclear imaging all have a role in the diagnosis of spinal infection. MRI continues to be the gold standard for the imaging diagnosis of spinal infections. ⁶⁷Gallium citrate and Tc-99m-methylene diphosphonate scintigraphy have become the standard for nuclear imaging of the spine. Fluorine-18-fluorodeoxyglucose positron emission tomography, strepavidin/¹¹¹In-biotin, and ^99m-ciprofloxacin have shown promise for aiding in the diagnosis and evaluation of spinal infection but warrant further study.
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Vertebral osteomyelitis is most commonly due to pyogenic or granulomatous infection and typically results in the combined involvement of the intervertebral disc and adjacent vertebral bodies. Non-infective causes include the related conditions of chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. Occasionally, these conditions may present purely within the vertebral body, resulting in various combinations of vertebral marrow oedema and sclerosis, destructive lesions of the vertebral body and pathological vertebral collapse, thus mimicking neoplastic disease. This review illustrates the imaging features of vertebral osteomyelitis without disc involvement, with emphasis on magnetic resonance imaging (MRI) findings.
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Original articlesEarly diagnosis of single segment vertebral osteomyelitis—mr pattern and its characteristics

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Vertebral osteomyelitisassessment using MR

Radiology

MR Imaging of vertebral osteomyelitis revisited

AJR

Spinal TuberculosisAtypical Observations at MR Imaging

Radiology

Early Diagnosis of Spinal Tuberculosis by MRI

Bone Joint Surg Br

Infectious spondylitisMRI characteristics

J Formos Med Assoc

The radiological diagnosis of tuberculosis of the adult spine

Skeletal Radiol

MR evaluation of tuberculous spondylitis

Acta Radiologica

Infectious and inflammatory processes of the spine

Radiol Clin North Am

Original articles
Early diagnosis of single segment vertebral osteomyelitis—mr pattern and its characteristics