Trudności diagnostyczne wynikające ze zmienności obrazów morfologicznych spondylodiscitis w obrazowaniu MR

Abstract

SummaryBackground:Spinal infection (discitis; spondylodiscitis) presents a wide spectrum of pathologies. The method of choice for spondylodiscitis imaging is magnetic resonance (MR). It provides detailed anatomical information, especially concerning epidural space and spinal cord. The main aim of this article is the description and evaluation of spondylodiscitis morphological variation visible in magnetic resonance imaging.Material/Methods:In this article we retrospectively analysed the patients diagnosed at the Department of Radiology of the Provincial Hospital No 2 in Rzeszów between October 2009 and October 2011. The subjects involved a group of five women aged 41–74 (mean 56.3 years) and eight men aged 46–69 (mean 61,3 years). All patients had spondylodiscitis symptoms. All patients underwent MRI examination before and after the contrast enhancement. In three patients additional CT examination was performed.Results:Following the MRI procedure all patients were diagnosed with typical symptoms of spondylodiscitis. It also revealed a number of pathologies resulting from morphological spondylodiscitis variation. Other pathologies found on the MR images of the study group patients involved epidural intra-canal spinal pathological masses causing spinal cord compression, lung abscess, pyothorax, paravertebral abscesses and epidural empyemas, abscess between adjacent vertebral bodies, abscesses beneath anterior longitudinal ligament, and iliopsoas muscle abscesses. In all cases a destruction of vertebral bodies with end plates loss restriction and cortical layer discontinuity was observed. Moreover, one person was diagnosed with pathological vertebral body fractures and liquefactive necrosis of the vertebral body.Conclusions:Spondylodiscitis manifests itself in a great number of morphological variations visible on the radiological images. Apart from ordinary features of vertebral bodies and discs, progressive spinal destruction is observed together with reactive bone changes and soft tissue infiltration. The latter leads to a number of complications e.g. abscesses or even fistulas and also to the formation of obstacles in radiological images. The knowledge of radiological images together with overall evaluation of clinical and laboratory features enables a proper diagnosis.

Magnetic Resonance Imaging in Differentatial Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis

“…Prevalence of spondylitis is estimated at 0.4–2 cases per 100 000/year [ 1 ]. However, latest reports point to increasing incidence all over the world, particularly in the Southern Africa, where spondylitis is diagnosed in 11% of all patients reporting to the doctor due to back pain [ 2 ].…”

Role of Magnetic Resonance Imaging in Differentiating Spondylitis from Vertebral Metastasis

“…The second phase of contrast intensification pattern into the rim enhancement did not increase as it consisted of a set of abscess fluid surrounded by a thick wall of granulation tissues. Spondylodiscitis, epidural and paravertebral abscesses could be more easily detected on the T2WI sequence [ 5 10 ].…”

“…Ongoing disease progression can cause side anterior vertebral collapse, leading to the formation of a wedge shape anteriorly, and the development of vertebral deformity angulation and gibbus. Subsequent deployment through discs allowed an overview of spondylodiscitis and then of the successive vertebral corpus [ 10 20 21 ].…”

“…Vertebrae are the most common sites of infection, which account for about 2% to 7% of all cases of musculoskeletal infections. The incidence increases along with the increase in age, i.e., from 0.3% per 100,000 population at the age of less than 20 years to 6.5% per 100,000 population at the age of 70 years [ 8 9 10 ].…”

“…Difficulties arise especially when the classic picture is not observed or when unusual patterns emerge (atypical picture). Atypical MRI images, either due to infections or vertebral metastasis, should be identified properly to avoid missing the diagnosis [ 6 10 ].…”