Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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MR Imaging for the Differentiation of Early Infectious Spondylitis and Modic Type I Change in the Lumbar Spine

요추의 초기 감염성 척추염과 Modic I형 변화의 감별: 자기공명영상 소견을 중심으로

  • Kwon, Jong-Won (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoon, Young-Cheol (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Sang-Hee (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jung, Jee-Young (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choe, Bong-Keun (Department of Preventive Medicine, School of Medicine, Kyung Hee University)
  • 권종원 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 윤영철 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 최상희 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 정지영 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 최봉근 (경희대학교 의학전문대학원 예방의학교실)
  • Received : 2009.12.15
  • Accepted : 2010.02.16
  • Published : 2010.06.01
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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.

목적: 요추에서 초기 감염성 척추염과 Modic I형 퇴행성 척추 변화는 자기공명영상에서 유사한 신호강도를 보여 감별이 어려울 수가 있다. 본 연구에서는 초기 감염성 척추염과 Modic I형 퇴행성 척추변화를 감별하는 도움이 되는 자기공명영상 소견을 알아보고자 하였다. 대상과 방법: 조영 증강 자기공명영상에서 척추종판 주위 골수에 부종이 있는 25명의 환자(11예의 감염성 척추염과 14예의 Modic I형 퇴행성 척추)를 대상으로 하였다. 골수 변화의 경계와 조영증강 여부, T1 강조영상에서 척추 종판의 미란 또는 파괴 여부, T2 강조영상에서 추간판의 신호강도 변화와 조영증강 여부, 그리고 척추 주위 연부조직병변 여부 등을 분석하였다. 결과: 감염성 척추염에서 골수 병변의 경계가 더 흐리게 보였으며, 척추 종판에 파괴가 보였고, Modic 변화에서는 척추 종판의 미란이 보였다. 조영 증강 영상에서 퇴행성 척추 1예를 제외하고 모두 척추체에 조영증강이 보였다. 감염성 척추염과 퇴행성 변화 모두 추간판은 T2 강조영상에서 신호강도가 증가하여 있고 조영증강이 되었다. 척추주위 연부조직 병변은 감염성 척추염에서 더 많이 보였다. 결론: 초기 감염성 척추염의 유용한 소견으로는 척추 종판의 파괴, T1 강조영상에서 흐린 골수 병변의 경계, 그리고 척추 주위 연부 조직 병변 등이 있다.

Keywords

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