J Korean Radiol Soc.  1998 Mar;38(3):523-529. 10.3348/jkrs.1998.38.3.523.

Pyogenic Spondylitis: MR Imaging Findings

• Cho SY
• Kim YH
• Chung HW
• Kang HS

• KMID: 2201414
• DOI: http://doi.org/10.3348/jkrs.1998.38.3.523

Abstract

PURPOSE: To prevent permanent neurologic deficit and/or spinal deformity in pyogenic spondylitis earlydiagnosis and prompt treatment are essential. The purpose of this study is to determine the MR imaging findings ofpyogenic spondylitis.
MATERIALS AND METHODS
In 31 patients with pathologically or clinically proven pyogenicspondylitis, MR images(31, T1-weighted ; 30, T2-weighted ; 31, Gd-enhanced T1-weighted) were retrospectivelyanalyzed. Analysis focused on the signal intensity and enhancement pattern of involved vertebral bodies andintervertebral discs, as well as paravertebral soft tissue abnormality.
RESULTS
A total of 77 vertebral bodies(mean, 2.5 per patient) were involved. Signal intensity was low in 58 of 77 T1-weighted images, high in 63 of 75T2-weighted images and in 72 of 77 contrast-enhanced T1-weighted images, enhancement was diffuse. A total of 47intervertebral discs were involved. Signal intensity was low or intermediate in all 47 T1-weighted images, andhigh or intermediate in 38/46 T2-weighted images ; in 24 of 38 contrast-enhanced T1-weighted images, signalintensity was peripheral, and in 14, enhancement was diffuse. Twenty-six patients showed diffusely enhancedparavertebral soft tissue abnormality and in 14, the largest diameter was less than 1cm.
CONCLUSION
With regardto vertebral bodies, MR imaging findings of pyogenic spondylitis are low signal intensity on T1-weighted images,and high or intermediate signal intensity on T2-weighted images, together with diffuse enhancement. Forintervertebral discs, signal intensity was low on T1-weighted images, high on T2-weighted images, and peripheralor diffuse enhancement was seen. Diffusely enhanced small paravertebral soft tissue abnormality was also present.

Keyword

Spine, infection; Spine, MR

MeSH Terms

Congenital Abnormalities
Humans
Magnetic Resonance Imaging*
Neurologic Manifestations
Spondylitis*

Figure

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  Fig. 1. 38-year-old woman with pyogenic spondylitis who had back pain for 1 month. A. Tl-weighted sagittal image shows decreased signal intensity in the T10 and Til vertebral bodies with focal disruption of the endplate(arrow). Intervening disc shows decrease in its height and signal intensity. B. T2-weighted sagittal image shows increased signal intensity in the same level of the vertebral bodies and the intervertebral disc with abscence of a nuclear cleft. C. Gadolinium enhanced Tl-weighted sagittal image shows diffuse enhancement of involving vertebral bodies and subtle enhancement of intervening disc. D. Gadolinium enhanced Tl-weighted axial image shows diffuse enhancement of the paravertebral soft tissue (white arrows) with focal disruption at the anterior cortical margin of T10 (black arrow).

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  Fig. 2. 50-year-old man with pyogenic spondylitis who had back pain for 3 years. A. Tl-weighted sagittal image shows increased signal intensity in the Til to L4 vertebral bodies. These vertebral bodies are fused partially due to previous operation(arrow heads). Intervening discs show decrease in their height and signal intensity(arrow). B. T2-weighted sagittal image shows persistently increased signal intensity in the same level of the vertebral bodies and high signal intensity of T12-L1 and Ll-2 intervertebral discs. C. Gadolinium enhanced Tl-weighted sagittal image dose not show obvious enhancement involving vertebral bodies. But some intervertebral discs (T12-L1, Ll-2) are enhanced peripherally(arrow).

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  Fig. 3. 21-year-old man with staphylococcal spondylitis who had back pain for 1 month. A. Tl-weighted sagittal image shows decreased signal intensity in the L4 and L5 vertebral bodies(open arrows). Intervening disc shows diffuse low signal intensity(arrow). B. T2-weighted sagittal image shows persistent low signal intensity in the L4 and L5 vertebral bodies(open arrows). But the intervening disc shows high signal intensity with abscence of a nuclear cleft(arrow). C. Gadolinium enhanced Tl-weighted sagittal image shows diffuse enhancement of involving vertebral bodies (open arrows) and peripheral enhancement of intervening disc(arrow).

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  Fig. 4. 23-year-old man with pyogenic spondylitis who had back pain for 2 months. A. Tl-weighted sagittal image shows decreased signal intensity in the L3, L4 and, L5 vertebral bodies with focal disruption of the endplates(black arrows). Intervening discs show decreased signal intensity(white arrows). B. T2-weighted sagittal image shows increased signal intensity in the same level of the vertebral bodies but inhomogenous low signal intensity of the intervening discs with abscence of a nuclear clefts(arrows). C. Gadolinium enhanced Tl-weighted sagittal image shows diffuse enhancement of involving vertebral bodies and peripheral enhancement of intervening discs(arrows).

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