Korean Journal of Radiology

  • 제17권5호
  • /
  • Pages.565-580
  • /
  • 2016
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Magnetic Resonance Imaging Findings of Early Spondylodiscitis: Interpretive Challenges and Atypical Findings

  • 투고 : 2015.04.28
  • 심사 : 2016.04.25
  • 발행 : 2016.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

MR findings of early infectious spondylodiscitis are non-specific and may be confused with those of other conditions. Therefore, it is important to recognize early MR signs of conditions, such as inappreciable cortical changes in endplates, confusing marrow signal intensities of vertebral bodies, and inflammatory changes in paraspinal soft tissues, and subligamentous and epidural spaces. In addition, appreciation of direct inoculation, such as in iatrogenic spondylodiscitis may be important, because the proportion of patients who have undergone recent spine surgery or a spinal procedure is increasing. In this review, the authors focus on the MR findings of early spondylodiscitis, atypical findings of iatrogenic infection, and the differentiation between spondylodiscitis and other disease entities mimicking infection.

키워드

참고문헌

  1. Diehn FE. Imaging of spine infection. Radiol Clin North Am 2012;50:777-798 https://doi.org/10.1016/j.rcl.2012.04.001
  2. Leone A, Dell'Atti C, Magarelli N, Colelli P, Balanika A, Casale R, et al. Imaging of spondylodiscitis. Eur Rev Med Pharmacol Sci 2012;16 Suppl 2:8-19
  3. DeSanto J, Ross JS. Spine infection/inflammation. Radiol Clin North Am 2011;49:105-127 https://doi.org/10.1016/j.rcl.2010.07.018
  4. Gurbuz MS, Berkman MZ. Spondylodiscitis occurring after diagnostic lumbar puncture: a case report. Case Rep Infect Dis 2013;2013:843592
  5. Mackenzie AR, Laing RB, Smith CC, Kaar GF, Smith FW. Spinal epidural abscess: the importance of early diagnosis and treatment. J Neurol Neurosurg Psychiatry 1998;65:209-212 https://doi.org/10.1136/jnnp.65.2.209
  6. Dunbar JA, Sandoe JA, Rao AS, Crimmins DW, Baig W, Rankine JJ. The MRI appearances of early vertebral osteomyelitis and discitis. Clin Radiol 2010;65:974-981 https://doi.org/10.1016/j.crad.2010.03.015
  7. Ziegelbein J, El-Khoury GY. Early spondylodiscitis presenting with single vertebral body involvement: a report of two cases. Iowa Orthop J 2011;31:219-224
  8. Ratcliffe JF. An evaluation of the intra-osseous arterial anastomoses in the human vertebral body at different ages. A microarteriographic study. J Anat 1982;134(Pt 2):373-382
  9. Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 2010;65 Suppl 3:iii11-iii24
  10. Ratcliffe JF. Anatomic basis for the pathogenesis and radiologic features of vertebral osteomyelitis and its differentiation from childhood discitis. A microarteriographic investigation. Acta Radiol Diagn (Stockh) 1985;26:137-143 https://doi.org/10.1177/028418518502600204
  11. Wiley AM, Trueta J. The vascular anatomy of the spine and its relationship to pyogenic vertebral osteomyelitis. J Bone Joint Surg Br 1959;41-B:796-809 https://doi.org/10.1302/0301-620X.41B4.796
  12. Bergman I, Wald ER, Meyer JD, Painter MJ. Epidural abscess and vertebral osteomyelitis following serial lumbar punctures. Pediatrics 1983;72:476-480
  13. Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ. Hematogenous pyogenic spinal infections and their surgical management. Spine (Phila Pa 1976) 2000;25:1668-1679 https://doi.org/10.1097/00007632-200007010-00010
  14. Go JL, Rothman S, Prosper A, Silbergleit R, Lerner A. Spine infections. Neuroimaging Clin N Am 2012;22:755-772 https://doi.org/10.1016/j.nic.2012.06.002
  15. Ratcliffe JF. The arterial anatomy of the developing human dorsal and lumbar vertebral body. A microarteriographic study. J Anat 1981;133(Pt 4):625-638
  16. Babinchak TJ, Riley DK, Rotheram EB Jr. Pyogenic vertebral osteomyelitis of the posterior elements. Clin Infect Dis 1997;25:221-224 https://doi.org/10.1086/514529
  17. Turunc T, Demiroglu YZ, Uncu H, Colakoglu S, Arslan H. A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect 2007;55:158-163 https://doi.org/10.1016/j.jinf.2007.04.002
  18. Lee CM, Lee S, Bae J. Contiguous spinal metastasis mimicking infectious spondylodiscitis. J Korean Soc Radiol 2015;73:408-412 https://doi.org/10.3348/jksr.2015.73.6.408
  19. Sans N, Faruch M, Lapegue F, Ponsot A, Chiavassa H, Railhac JJ. Infections of the spinal column--spondylodiscitis. Diagn Interv Imaging 2012;93:520-529 https://doi.org/10.1016/j.diii.2012.04.003
  20. Kim YJ, Lee JY, Kim BM, Kim YM, Min SH. MRI findings on iatrogenic spinal infection following various pain management procedures. J Korean Soc Radiol 2014;71:296-303 https://doi.org/10.3348/jksr.2014.71.6.296
  21. Dullerud R, Nakstad PH. Side effects and complications of automated percutaneous lumbar nucleotomy. Neuroradiology 1997;39:282-285 https://doi.org/10.1007/s002340050410
  22. Guyer RD, Ohnmeiss DD, Mason SL, Shelokov AP. Complications of cervical discography: findings in a large series. J Spinal Disord 1997;10:95-101
  23. Jimenez-Mejias ME, de Dios Colmenero J, Sanchez-Lora FJ, Palomino-Nicas J, Reguera JM, Garcia de la Heras J, et al. Postoperative spondylodiskitis: etiology, clinical findings, prognosis, and comparison with nonoperative pyogenic spondylodiskitis. Clin Infect Dis 1999;29:339-345 https://doi.org/10.1086/520212
  24. Sung S, Kwon JW. Image-guided percutaneous needle biopsy for infectious spondylitis: factors affecting culture positivity. J Korean Soc Radiol 2015;73:300-306 https://doi.org/10.3348/jksr.2015.73.5.300
  25. Jevtic V. Vertebral infection. Eur Radiol 2004;14 Suppl 3:E43-E52 https://doi.org/10.1007/s10406-004-0078-1
  26. Jung NY, Jee WH, Ha KY, Park CK, Byun JY. Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. AJR Am J Roentgenol 2004;182:1405-1410 https://doi.org/10.2214/ajr.182.6.1821405
  27. Thurnher MM, Bammer R. Diffusion-weighted magnetic resonance imaging of the spine and spinal cord. Semin Roentgenol 2006;41:294-311 https://doi.org/10.1053/j.ro.2006.07.003
  28. Eastwood JD, Vollmer RT, Provenzale JM. Diffusion-weighted imaging in a patient with vertebral and epidural abscesses. AJNR Am J Neuroradiol 2002;23:496-498
  29. Moritani T, Kim J, Capizzano AA, Kirby P, Kademian J, Sato Y. Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections. Br J Radiol 2014;87:20140011 https://doi.org/10.1259/bjr.20140011
  30. Millot F, Bonnaire B, Clavel G, Deramond H, Fardellone P, Grados F. Hematogenous Staphylococcus aureus discitis in adults can start outside the vertebral body. Joint Bone Spine 2010;77:76-77 https://doi.org/10.1016/j.jbspin.2009.10.010
  31. Tali ET. Spinal infections. Eur J Radiol 2004;50:120-133 https://doi.org/10.1016/j.ejrad.2003.10.022
  32. Jevtic V. Magnetic resonance imaging appearances of different discovertebral lesions. Eur Radiol 2001;11:1123-1135 https://doi.org/10.1007/s003300000727
  33. Hong SH, Choi JY, Lee JW, Kim NR, Choi JA, Kang HS. MR imaging assessment of the spine: infection or an imitation? Radiographics 2009;29:599-612 https://doi.org/10.1148/rg.292085137
  34. Tyrrell PN, Cassar-Pullicino VN, McCall IW. Spinal infection. Eur Radiol 1999;9:1066-1077 https://doi.org/10.1007/s003300050793
  35. Bron JL, de Vries MK, Snieders MN, van der Horst-Bruinsma IE, van Royen BJ. Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited. Clin Rheumatol 2009;28:883-892 https://doi.org/10.1007/s10067-009-1151-x
  36. Battikha JG, Garcia JF, Wettstein P. Aspects of atypical degenerative lesions of vertebrae. Skeletal Radiol 1981;6:103-107 https://doi.org/10.1007/BF00347571
  37. Kwon JW, Yoon YC, Choi SH, Jung JY, Choe BK. MR imaging for the differentiation of early infectious spondylitis and modic type I change in the lumbar spine. J Korean Soc Radiol 2010;62:563-570 https://doi.org/10.3348/jksr.2010.62.6.563
  38. Oztekin O, Calli C, Kitis O, Adibelli ZH, Eren CS, Apaydin M, et al. Reliability of diffusion weighted MR imaging in differentiating degenerative and infectious end plate changes. Radiol Oncol 2010;44:97-102
  39. Smith AS, Blaser SI. Infectious and inflammatory processes of the spine. Radiol Clin North Am 1991;29:809-827
  40. Cuenod CA, Laredo JD, Chevret S, Hamze B, Naouri JF, Chapaux X, et al. Acute vertebral collapse due to osteoporosis or malignancy: appearance on unenhanced and gadoliniumenhanced MR images. Radiology 1996;199:541-549 https://doi.org/10.1148/radiology.199.2.8668809
  41. Palmer WE, Suri R, Kattapuram SV. Benign versus malignant vertebral collapse: value of a fracture line on MR images. Radiology (Suppl) 1999:213-293
  42. Yuh WT, Zachar CK, Barloon TJ, Sato Y, Sickels WJ, Hawes DR. Vertebral compression fractures: distinction between benign and malignant causes with MR imaging. Radiology 1989;172:215-218 https://doi.org/10.1148/radiology.172.1.2740506
  43. Van Lom KJ, Kellerhouse LE, Pathria MN, Moreland SI, Brown JJ, Zlatkin M, et al. Infection versus tumor in the spine: criteria for distinction with CT. Radiology 1988;166:851-855 https://doi.org/10.1148/radiology.166.3.3340783
  44. Shih TT, Huang KM, Hou SM. Early diagnosis of single segment vertebral osteomyelitis--MR pattern and its characteristics. Clin Imaging 1999;23:159-167 https://doi.org/10.1016/S0899-7071(99)00108-4
  45. Wagner AL, Murtagh FR, Arrington JA, Stallworth D. Relationship of Schmorl's nodes to vertebral body endplate fractures and acute endplate disk extrusions. AJNR Am J Neuroradiol 2000;21:276-281
  46. Park P, Tran NK, Gala VC, Hoff JT, Quint DJ. The radiographic evolution of a Schmorl's node. Br J Neurosurg 2007;21:224-227 https://doi.org/10.1080/02688690701317169
  47. Grive E, Rovira A, Capellades J, Rivas A, Pedraza S. Radiologic findings in two cases of acute Schmorl's nodes. AJNR Am J Neuroradiol 1999;20:1717-1721
  48. Friedmand DP, Hills JR. Cervical epidural spinal infection: MR imaging characteristics. AJR Am J Roentgenol 1994;163:699-704 https://doi.org/10.2214/ajr.163.3.8079871
  49. Kuker W, Mull M, Mayfrank L, Topper R, Thron A. Epidural spinal infection. Variability of clinical and magnetic resonance imaging findings. Spine (Phila Pa 1976) 1997;22:544-550; discussion 551 https://doi.org/10.1097/00007632-199703010-00017
  50. Ortiz AO, Bordia R. Injury to the vertebral endplate-disk complex associated with osteoporotic vertebral compression fractures. AJNR Am J Neuroradiol 2011;32:115-120 https://doi.org/10.3174/ajnr.A2223
  51. Abdel-Wanis ME, Solyman MT, Hasan NM. Sensitivity, specificity and accuracy of magnetic resonance imaging for differentiating vertebral compression fractures caused by malignancy, osteoporosis, and infections. J Orthop Surg (Hong Kong) 2011;19:145-150 https://doi.org/10.1177/230949901101900203
  52. Fouquet B, Goupille P, Jattiot F, Cotty P, Lapierre F, Valat JP, et al. Discitis after lumbar disc surgery. Features of "aseptic" and "septic" forms. Spine (Phila Pa 1976) 1992;17:356-358 https://doi.org/10.1097/00007632-199203000-00019
  53. Narvaez J, Nolla JM, Narvaez JA, Martinez-Carnicero L, De Lama E, Gomez-Vaquero C, et al. Spontaneous pyogenic facet joint infection. Semin Arthritis Rheum 2006;35:272-283 https://doi.org/10.1016/j.semarthrit.2005.09.003
  54. Weingarten TN, Hooten WM, Huntoon MA. Septic facet joint arthritis after a corticosteroid facet injection. Pain Med 2006;7:52-56 https://doi.org/10.1111/j.1526-4637.2006.00089.x
  55. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev 2000;23:175-204; discussion 205 https://doi.org/10.1007/PL00011954
  56. Tompkins M, Panuncialman I, Lucas P, Palumbo M. Spinal epidural abscess. J Emerg Med 2010;39:384-390 https://doi.org/10.1016/j.jemermed.2009.11.001
  57. Ehara S, Khurana JS, Kattapuram SV. Pyogenic vertebral osteomyelitis of the posterior elements. Skeletal Radiol 1989;18:175-178 https://doi.org/10.1007/BF00360963
  58. Heenan SD, Britton J. Septic arthritis in a lumbar facet joint: a rare cause of an epidural abscess. Neuroradiology 1995;37:462-464 https://doi.org/10.1007/BF00600094
  59. Hickey NA, White PG. Septic arthritis of a lumbar facet joint causing multiple abscesses. Clin Radiol 2000;55:481-483 https://doi.org/10.1053/crad.2000.0091
  60. Numaguchi Y, Rigamonti D, Rothman MI, Sato S, Mihara F, Sadato N. Spinal epidural abscess: evaluation with gadolinium-enhanced MR imaging. Radiographics 1993;13:545-559; discussion 559-560 https://doi.org/10.1148/radiographics.13.3.8316663
  61. Sandhu FS, Dillon WP. Spinal epidural abscess: evaluation with contrast-enhanced MR imaging. AJNR Am J Neuroradiol 1991;12:1087-1093
  62. Ross JS, Zepp R, Modic MT. The postoperative lumbar spine: enhanced MR evaluation of the intervertebral disk. AJNR Am J Neuroradiol 1996;17:323-331

피인용 문헌

  1. Surgical site infections in spinal neurosurgery vol.98, pp.5, 2016, https://doi.org/10.17750/kmj2017-796
  2. Lumbar Vertebral Endplate Defects on Magnetic Resonance Images: Classification, Distribution Patterns, and Associations with Modic Changes and Disc Degeneration vol.43, pp.13, 2016, https://doi.org/10.1097/brs.0000000000002450
  3. Performance of the deep convolutional neural network based magnetic resonance image scoring algorithm for differentiating between tuberculous and pyogenic spondylitis vol.8, pp.None, 2016, https://doi.org/10.1038/s41598-018-31486-3
  4. Nontraumatic Spinal Cord Compression: MRI Primer for Emergency Department Radiologists vol.39, pp.6, 2016, https://doi.org/10.1148/rg.2019190024
  5. An institutional review of tuberculosis spine mimics on MR imaging: Cases of mistaken identity vol.67, pp.6, 2016, https://doi.org/10.4103/0028-3886.273630
  6. Vertebral Bone Marrow and Endplate Assessment on MR Imaging for the Differentiation of Modic Type 1 Endplate Changes and Infectious Spondylodiscitis vol.9, pp.3, 2020, https://doi.org/10.3390/jcm9030826
  7. Nicht traumatische Rückenmarkskompression: MRT-Prinzipien für die Notaufnahme vol.10, pp.4, 2016, https://doi.org/10.1055/a-1128-5509
  8. Lumbosacral discitis as a rare complication of laparoscopic sacrocolpopexy vol.31, pp.11, 2020, https://doi.org/10.1007/s00192-020-04331-3
  9. Pathophysiology and MRI Findings of Infectious Spondylitis and the Differential Diagnosis vol.82, pp.6, 2016, https://doi.org/10.3348/jksr.2021.0138
  10. MRI Features Associated With the Detection of Microbial Pathogens by CT-Guided Biopsy in Septic Spondylodiscitis vol.28, pp.1, 2016, https://doi.org/10.1097/rhu.0000000000001683
  11. Proton Density Fat Fraction Spine MRI for Differentiation of Erosive Vertebral Endplate Degeneration and Infectious Spondylitis vol.12, pp.1, 2016, https://doi.org/10.3390/diagnostics12010078