J Korean Soc Radiol.  2010 Jun;62(6):563-570.

MR Imaging for the Differentiation of Early Infectious Spondylitis and Modic Type I Change in the Lumbar Spine

• Kwon JW
• Yoon YC
• Choi SH
• Jung JY
• Choe BK

Abstract

PURPOSE
To evaluate magnetic resonance (MR) imaging findings for the differentiation of early infectious spondylitis and Modic type I change in the lumbar spine.
MATERIALS AND METHODS
Contrast-enhanced lumbar spine MR images with bone marrow edema adjacent to the endplates of 25 patients (14 men, 11 women; mean age 53.7 years) were evaluated. Margin and enhancement in the bone marrow changes, erosion or destruction of endplates on T1-weighted sagittal MR images, T2 signal intensity and enhancement in the intervertebral disks, as well as the presence of paravertebral soft tissue were evaluated. The final diagnoses were 11 cases of infectious spondylitis and 14 cases of Modic type I change.
RESULTS
The margin of bone marrow changes was more blurred in infectious spondylitis than in Modic type I change. The endplates for infectious spondylitis showed destructions, and Modic change erosions. On postcontrast images, all the cases except for only one with degenerative disease were enhanced in the vertebral bodies. Intervertebral disks showed T2 hyperintensities and were enhanced in both the infectious spondylitis and Modic change. Paravertebral soft tissue was seen more commonly in infectious spondylitis.
CONCLUSION
The useful findings of early infectious spondylitis include endplate destruction, blurred margins of the bone marrow changes on T1-weighted images, and the presence of paravertebral soft tissue.

MeSH Terms

Bone Marrow
Edema
Humans
Intervertebral Disc
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Male
Spine
Spondylitis

Figure

• 

  Fig. 1 Infectious spondylitis in a 33-year-old woman with lower back pain. A. Schematic picture illustrating the change of infectious spondylitis. B. The T1-weighted sagittal image (TR/TE = 350/17 msec) shows decreased signal intensities of the vertebral bodies of L3 and L4. There are focally destructed vertebral endplates at the inferior aspect of L3 (arrow) and the superior aspect of the L4 vertebral body. The margins of bone marrow changes in the L3 and L4 vertebral bodies are not demarcated. C. The T2-weighted sagittal image (TR/TE = 2200/102 msec) shows increased signals of the adjacent portions of the L3 and L4 vertebral bodies. Hyperintensity equivalent to fluid is seen in the L3-4 disk. D. The contrast enhanced T1-weighted sagittal image (TR/TE = 350/17 msec) shows discrete patchy enhancement in the vertebral bodies of L3 and L4.

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  Fig. 2 Modic type I change in a 37-year-old woman with low back pain. A. Schematic picture illustrating the changes of Modic type I change. B. The sagittal T1-weighted fast spin-echo MR image (TR/TE = 650/17 msec) shows relatively well-demarcated bone marrow abnormalities of low signal intensity at the L4 and L5 bodies (arrowheads). There is an eroded endplate with an irregular low signal line of the inferior aspect of L4 (arrow). C. The T2-weighted image (TR/TE = 3000/110 msec) reveals increased signal intensity involving the disk (arrow) and adjacent vertebral bodies. An eroded endplate is also seen at the inferior aspect of L4. D. The contrast enhanced T1-weighted image (TR/TE = 650/17 msec) shows patchy enhancement in the L4 and L5 vertebral bodies.

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