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MR Imaging Findings in Spinal Infections: Rules or Myths?¹

¹ From the Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa. From the 2001 RSNA scientific assembly. Received June 23, 2002; revision requested August 22; revision received October 6; accepted December 19. Address correspondence to H.P.L., Radiologisches Institut, Kantonsspital Basel, Petersgraben 4, 4031 Basel, Switzerland (e-mail: hans-peter.ledermann@gmx.ch).

View larger version (105K): [in a new window]   Figure 1a. Sagittal MR images in a 53-year-old woman who was recently discharged after treatment of a septic hip. Worsening lumbar pain and fever led to rehospitalization. (a) T1-weighted fat-suppressed fast multiplanar spoiled gradient-recalled-echo image (200/3, flip angle of 90°) shows apparent increased disk height (arrow) between lumbar vertebrae L4-5, which is related to destruction of the superior endplate of L5 (arrowhead) and decreased height of the body of L4. (b) T2-weighted STIR image (4,600/68/150) reveals an oval collection of fluid-equivalent SI (arrow) in the enlarged disk space and effacement of the nuclear cleft in comparison to the other lumbar disks. (c) T1-weighted fat-suppressed contrast-enhanced fast multiplanar spoiled gradient-recalled-echo image (200/3, flip angle of 90°) reveals rim enhancement (arrow) of the disk space at L4-5 with a nonenhancing center indicative of a large intradiskal abscess. Note diffuse contrast enhancement (arrowhead) of the disk space at L5-S1. Surgical therapy resulted in a corpectomy of L5 with diskectomies at L4-5 and L5-S1. Intraoperative culture proved Staphylococcus aureus infection.

View larger version (103K): [in a new window]   Figure 1b. Sagittal MR images in a 53-year-old woman who was recently discharged after treatment of a septic hip. Worsening lumbar pain and fever led to rehospitalization. (a) T1-weighted fat-suppressed fast multiplanar spoiled gradient-recalled-echo image (200/3, flip angle of 90°) shows apparent increased disk height (arrow) between lumbar vertebrae L4-5, which is related to destruction of the superior endplate of L5 (arrowhead) and decreased height of the body of L4. (b) T2-weighted STIR image (4,600/68/150) reveals an oval collection of fluid-equivalent SI (arrow) in the enlarged disk space and effacement of the nuclear cleft in comparison to the other lumbar disks. (c) T1-weighted fat-suppressed contrast-enhanced fast multiplanar spoiled gradient-recalled-echo image (200/3, flip angle of 90°) reveals rim enhancement (arrow) of the disk space at L4-5 with a nonenhancing center indicative of a large intradiskal abscess. Note diffuse contrast enhancement (arrowhead) of the disk space at L5-S1. Surgical therapy resulted in a corpectomy of L5 with diskectomies at L4-5 and L5-S1. Intraoperative culture proved Staphylococcus aureus infection.

View larger version (114K): [in a new window]   Figure 1c. Sagittal MR images in a 53-year-old woman who was recently discharged after treatment of a septic hip. Worsening lumbar pain and fever led to rehospitalization. (a) T1-weighted fat-suppressed fast multiplanar spoiled gradient-recalled-echo image (200/3, flip angle of 90°) shows apparent increased disk height (arrow) between lumbar vertebrae L4-5, which is related to destruction of the superior endplate of L5 (arrowhead) and decreased height of the body of L4. (b) T2-weighted STIR image (4,600/68/150) reveals an oval collection of fluid-equivalent SI (arrow) in the enlarged disk space and effacement of the nuclear cleft in comparison to the other lumbar disks. (c) T1-weighted fat-suppressed contrast-enhanced fast multiplanar spoiled gradient-recalled-echo image (200/3, flip angle of 90°) reveals rim enhancement (arrow) of the disk space at L4-5 with a nonenhancing center indicative of a large intradiskal abscess. Note diffuse contrast enhancement (arrowhead) of the disk space at L5-S1. Surgical therapy resulted in a corpectomy of L5 with diskectomies at L4-5 and L5-S1. Intraoperative culture proved Staphylococcus aureus infection.

View larger version (104K): [in a new window]   Figure 2a. Sagittal MR images in a 55-year-old woman who experienced progressive lumbar pain 7 weeks after surgical treatment of a colonic abscess. (a) T1-weighted spin-echo image (400/8) shows destruction of the endplates of the lumbar disk spaces L3-4 (upper arrow) and L4-5 (lower arrow). (b) T2-weighted STIR image (4,600/68/150) shows inhomogeneous hypointensity in the disk spaces L3-4 (upper arrow) and L4-5 (lower arrow) with loss of the nuclear cleft (positive nuclear cleft sign). (c) T1-weighted fat-suppressed spin-echo image (450/8) depicts suggested rim enhancement of the L3-4 (upper white arrow) and L4-5 (lower white arrow) disks and diffuse enhancement of the superior part of the S1 body (black arrow). Note extensive subdural phlegmon (arrowhead). Diskectomy of the segments L3-4 and L4-5 and anterior fusion were performed.

View larger version (108K): [in a new window]   Figure 2b. Sagittal MR images in a 55-year-old woman who experienced progressive lumbar pain 7 weeks after surgical treatment of a colonic abscess. (a) T1-weighted spin-echo image (400/8) shows destruction of the endplates of the lumbar disk spaces L3-4 (upper arrow) and L4-5 (lower arrow). (b) T2-weighted STIR image (4,600/68/150) shows inhomogeneous hypointensity in the disk spaces L3-4 (upper arrow) and L4-5 (lower arrow) with loss of the nuclear cleft (positive nuclear cleft sign). (c) T1-weighted fat-suppressed spin-echo image (450/8) depicts suggested rim enhancement of the L3-4 (upper white arrow) and L4-5 (lower white arrow) disks and diffuse enhancement of the superior part of the S1 body (black arrow). Note extensive subdural phlegmon (arrowhead). Diskectomy of the segments L3-4 and L4-5 and anterior fusion were performed.

View larger version (116K): [in a new window]   Figure 2c. Sagittal MR images in a 55-year-old woman who experienced progressive lumbar pain 7 weeks after surgical treatment of a colonic abscess. (a) T1-weighted spin-echo image (400/8) shows destruction of the endplates of the lumbar disk spaces L3-4 (upper arrow) and L4-5 (lower arrow). (b) T2-weighted STIR image (4,600/68/150) shows inhomogeneous hypointensity in the disk spaces L3-4 (upper arrow) and L4-5 (lower arrow) with loss of the nuclear cleft (positive nuclear cleft sign). (c) T1-weighted fat-suppressed spin-echo image (450/8) depicts suggested rim enhancement of the L3-4 (upper white arrow) and L4-5 (lower white arrow) disks and diffuse enhancement of the superior part of the S1 body (black arrow). Note extensive subdural phlegmon (arrowhead). Diskectomy of the segments L3-4 and L4-5 and anterior fusion were performed.

View larger version (113K): [in a new window]   Figure 3a. Sagittal MR images in a 70-year-old man with endocarditis, positive blood cultures for enterococci, and clinically presumed diskitis. (a) T1-weighted fat-suppressed fast multiplanar spoiled gradient-recalled-echo image (200/3, flip angle of 90°) shows intact vertebral endplates (arrowheads) at the L5-S1 disk. (b) T2-weighted STIR image (4,600/68/150) shows hyperintensity of the L5-S1 disk, intact vertebral endplates, and a preserved nuclear cleft (arrow). Only the ventral aspect of the L5 body shows discrete hyperintense alteration of the bone marrow. (c) T1-weighted contrast-enhanced fat-suppressed fast multiplanar spoiled gradient-recalled-echo image (200/3, flip angle of 90°) shows discrete focal contrast enhancement (arrow) of the disk, focal enhancement of the ventral aspect of L5 (white arrowhead), and subdural phlegmon (black arrowheads).

View larger version (113K): [in a new window]   Figure 3b. Sagittal MR images in a 70-year-old man with endocarditis, positive blood cultures for enterococci, and clinically presumed diskitis. (a) T1-weighted fat-suppressed fast multiplanar spoiled gradient-recalled-echo image (200/3, flip angle of 90°) shows intact vertebral endplates (arrowheads) at the L5-S1 disk. (b) T2-weighted STIR image (4,600/68/150) shows hyperintensity of the L5-S1 disk, intact vertebral endplates, and a preserved nuclear cleft (arrow). Only the ventral aspect of the L5 body shows discrete hyperintense alteration of the bone marrow. (c) T1-weighted contrast-enhanced fat-suppressed fast multiplanar spoiled gradient-recalled-echo image (200/3, flip angle of 90°) shows discrete focal contrast enhancement (arrow) of the disk, focal enhancement of the ventral aspect of L5 (white arrowhead), and subdural phlegmon (black arrowheads).

View larger version (107K): [in a new window]   Figure 3c. Sagittal MR images in a 70-year-old man with endocarditis, positive blood cultures for enterococci, and clinically presumed diskitis. (a) T1-weighted fat-suppressed fast multiplanar spoiled gradient-recalled-echo image (200/3, flip angle of 90°) shows intact vertebral endplates (arrowheads) at the L5-S1 disk. (b) T2-weighted STIR image (4,600/68/150) shows hyperintensity of the L5-S1 disk, intact vertebral endplates, and a preserved nuclear cleft (arrow). Only the ventral aspect of the L5 body shows discrete hyperintense alteration of the bone marrow. (c) T1-weighted contrast-enhanced fat-suppressed fast multiplanar spoiled gradient-recalled-echo image (200/3, flip angle of 90°) shows discrete focal contrast enhancement (arrow) of the disk, focal enhancement of the ventral aspect of L5 (white arrowhead), and subdural phlegmon (black arrowheads).