Magnetic Resonance Imaging Evaluation of Spinal Infections

Magnetic Resonance Imaging Evaluation of Spinal Infections

  • Vulchi Ranjith Kumar Post Graduate, Department of Radio-Diagnosis, Narayana Medical College & Hospital, Nellore, Andhra Pradesh, India
  • Rama Krishna Rao Baru Professor, Department of Radio-Diagnosis, Narayana Medical College & Hospital, Nellore, Andhra Pradesh, India

Abstract

Background: The advantage of Magnetic resonance imaging include multiplanar capabilities and soft-tissue contrast resolution, which is superior to that of CT. Magnetic resonance (MR) imaging is a powerful diagnostic tool that can be used to help evaluate spinal infection and to help distinguish between an infection and other clinical conditions. Aim of the current study is to evaluate various spectrum and types of spinal infections, and discussing the role of MRI in diagnosing them and their characterization. Subjects & Methods: This Hospital-based prospective study consists 30 patients with clinically suspected spinal infections and chronic non-resolving low backache referred to the department of Radiodiagnosis in a period of 2 years. Investigations include Complete blood count, ESR, sputum analysis for acid-fast bacilli and MRI of the spine. Results: 20 cases involved the lumbar spine, of which 12 were tubercular, seven were pyogenic, and one case was actinomycosis. In total 21 tubercular cases, 12 cases involved lumbar spine (57%), 8 cases affects the thoracic spine (38%), and 1 case involves the cervical spine (P = 0.562). the incidence of spondylodiscitis is common overall in the lumbar spine. 23.8% of tubercular and 12.5 %of pyogenic cases involved more than two vertebrae. T1 hypointensity is seen in 18 cases of tuberculosis (85%), 8 cases of pyogenic (75%), and 1 case of actinomycosis (100%) (P = 0.801). 4 cases showed preservation of disc height, among which three are tubercular (75%), and 1 was actinomycosis (25%). 85 % of tubercular and 100% of pyogenic cases showed disc narrowing. 81 % of tubercular and 100 % of pyogenic cases showed disc hyperintensity. Nine cases of tuberculosis (42.9%) and 3 cases of pyogenic (37.5 %) showed epidural abscess. 26 cases showed para vertebral extension of which 18 were tubercular (69.2 %), 7 were pyogenic (26.9 %) and 1 was actinomycosis (3.8 %). 94% of tubercular and 42 % of pyogenic abscesses showed a well-defined para spinal signal in cases of paraspinal extension. 15 of the 18(83%) tuberculosis, 3 of the 7 (42%)cases of pyogenic, and 1 case of actinomycosis showed subligamentous spread along more than three vertebrae. Heterogenous enhancement was noted in 12 of the 15 (80%) tubercular cases, 1 of the 3 (33%) pyogenic cases, and 1(100%) actinomycosis case. 71% tubercular cases and 2 of 8 (25%) cases showed predominant anterior 2/3rdinvolvement. Grade III or more (>50%) vertebral destruction was seen in 16 tubercular (76%) and 2 pyogenic cases (25%). Six cases showed skip lesions of which 5were tubercular and 1 was pyogenic. 5 of the 21 (23.8%) tubercular and 1 of the 8 (12.5%) pyogenic cases showed skip lesions. Conclusion: Awareness of atypical MR imaging at early infectious spondylitis is important to avoid diagnostic delay and unnecessary other diagnostic procedures. Several non-infectious conditions may simulate the spinal infections. Hence It is helpful to be aware of these diseases and their MR imaging features. With these points in mind, MR imaging can be very beneficial to patients with spinal infection. 

Downloads

Download data is not yet available.

References

1. Maiuri F, Gallicchio B, Manto A, Briganti F. Spondy- lodiscitis: clinical and magnetic resonance diagnosis. Spine. 1997;22(15):1741–1747. Available from: https://doi.org/10. 1097/00007632-199708010-00012.
2. Stefanovski N, Voris LPV. Pyogenic vertebral osteomyeli- tis: report of a series of 23 patients. Contemp Orthop. 1995;31(3):159–164.
3. Chew FS, Kline MJ. Diagnostic Yield of CT-guided Percuta- neous Aspiration Procedures in Suspected Spontaneous Infec- tious Diskitis. Radiology. 2001;218(1):211–214. Available from: https://dx.doi.org/10.1148/radiology.218.1.r01ja06211.
4. Cheung WY, Luk KDK. Pyogenic spondylitis. International
Orthopaedics. 2012;36:397–404. Available from: https://dx. doi.org/10.1007/s00264-011-1384-6.
5. Acharya J, Gibbs WN. Imaging spinal infection. Radiol Infect Dis. 2016;3:84–91. Available from: https://dx.doi.org/10.1016/ j.jrid.2016.03.001.
6. Reyes-Prieto A, Barquera B, Juárez O. Origin and Evolution of the Sodium -Pumping NADH: Ubiquinone Oxidoreductase. PLoS ONE. 2014;9:96696. Available from: https://dx.doi.org/ 10.1371/journal.pone.0096696.
7. Ruiz A, Post MJ, Sklar EM, Holz A. MR imaging of the infections of the cervical spine. Magn Reson Imaging Clin N Am. 2000;8(3):561–580.
8. Smith AS, Blaser SI. Infectious and inflammatory processes of the spine. Radiol Clin North Am. 1991;19:809–827.
9. The diagnosis of infections of the spine by modern imaging techniques. Orth Clin North Am. 1996;27(1):15–31.
10. Talbott JF, Shah VN, Uzelac A, Narvid J, Dumont RA, Chin CT, et al. Imaging-Based Approach to Extradural Infections of the Spine. Semin Ultrasound CT MR. 2018;39(6):570–586. Available from: https://dx.doi.org/10.1053/j.sult.2018.09.003.
11. Galhotra R, Jain T, Sandhu P, Galhotra V. Utility of magnetic resonance imaging in the differential diagnosis of tubercular and pyogenic spondylodiscitis. J Nat Sci Biol Med. 2015;6(2):388. Available from: https://dx.doi.org/10.4103/ 0976-9668.160016.
12. Jung NY, Jee WH, Ha KY, Park CK, Byun JY. Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. Am J Roentgenol. 2004;182(6):1405–1415. Available from: https://doi.org/10.2214/ajr.182.6.1821405.
13. Harada Y, Tokuda O, Matsunaga N. Magnetic resonance imaging characteristics of tuberculous spondylitis vs. pyogenic spondylitis. Clin Imaging. 2008;32:303–309. Available from: https://dx.doi.org/10.1016/j.clinimag.2007.03.015.
14. Chang MC, Wu HT, Lee CH, Liu CL, Chen TH. Tubercu- lous spondylitis and pyogenic spondylitis: comparative mag- netic resonance imaging features. Spine. 2006;31(7):782–790. Available from: https://doi.org/10.1097/01.brs.0000206385. 11684.d5.
15. Shanely DJ. Tuberculosis of the spine: imaging features. Am J Roentgenol. 1995;164:659–664. Available from: https://doi. org/10.2214/ajr.164.3.7863889.
16. Dagirmanjian A, Schils J, McHenry M, Modic MT. MR imaging of vertebral osteomyelitis revisited. Am J Roentgenol. 1996;167(6):1539–1543. Available from: https://dx.doi.org/10. 2214/ajr.167.6.8956593.
17. Smith AS, Blaser SI. Infectious and inflammatory processes of the spine. Radiol Clin North Am. 1991;29:809–827.
18. Varma R, Lander P, Assaf A. Imaging of Pyogenic Infectious Spondylodiskitis. Radiol Clin North Am. 2001;39(2):203–
213. Available from: https://dx.doi.org/10.1016/s0033- 8389(05)70273-6.
19. Sharif HS. Role of MR imaging in the management of spinal infections. Am J Roentgenol. 1992;158(6):1333–1345. Available from: https://dx.doi.org/10.2214/ajr.158.6.1590137.
Published
2020-12-31
How to Cite
Kumar, V. R., & Rama Krishna Rao Baru. (2020). Magnetic Resonance Imaging Evaluation of Spinal Infections. Asian Journal of Medical Radiological Research, 8(2), 80-87. https://doi.org/10.47009/ajmrr.2020.8.2.13
Section
Original Articles