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Reactive Bone Marrow Changes in Infectious Spondylitis: Quantitative Assessment with MR Imaging¹

¹ From the Department of Clinical Radiology (A.S., A.B., M.F.R.) and Clinic for Orthopedic Surgery (A.K.), University of Munich, Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany; and the Radiodiagnostic Department, Research Institute of Ophthalmology, Giza, Egypt (A.B.D.). Received February 24, 1999; revision requested April 23; final revision received April 14, 2000; accepted May 5. Address correspondence to A.S. (e-mail: axel.staebler@ikra.med.uni-muenchen.de).

PURPOSE: To evaluate diffuse, reactive bone marrow changes in unaffected vertebrae on magnetic resonance (MR) images in patients with proved infectious spondylitis.

MATERIALS AND METHODS: Percentage signal intensity increase of the unaffected bone marrow on contrast material–enhanced MR images (percentage enhancement) was calculated retrospectively in 22 cases of infectious spondylitis and 86 cases without bone marrow disease. Multiple regression analysis and Student t test statistics were performed.

RESULTS: Multiple regression analysis showed a significant influence of age and the presence of spondylitis on the values of percentage enhancement (P < .001). For those aged 35 years or younger, the mean percentage enhancement was 43.2% ± 4.0 for patients with infectious spondylitis (n = 3) and was 26.4% ± 8.6 for the control group (n = 23). For those older than 35 years, the mean percentage enhancement was 28.2% ± 12.2 for patients with infectious spondylitis (n = 19) and 17.5% ± 7.9 (P < .001) for the control group (n = 63). Six (27%) of 22 patients with infectious spondylitis showed abnormal percentage enhancement values in unaffected bone marrow when the upper limit of the normal value was 2 SDs above the mean of the control group.

CONCLUSION: On MR images, reactive bone marrow changes can be found in unaffected vertebrae in patients with infectious spondylitis. The signal intensity changes and increased percentage enhancement associated with this disease are similar to those of myeloproliferative and diffuse neoplastic disorders and bone marrow stimulation in hemolytic anemia.

Index terms: Bone marrow, diseases • Magnetic resonance (MR), contrast enhancement, 30.12143 • Spine, infection, 30.201 • Spine, MR, 30.12143 • Spondylitis, 30.29

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