Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections

T Moritani; J Kim; A A Capizzano; P Kirby; J Kademian; Y Sato

doi:10.1259/bjr.20140011

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Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections

Journal article

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Peer reviewed

Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections

T Moritani, J Kim, A A Capizzano, P Kirby, J Kademian and Y Sato

British journal of radiology, Vol.87(1041), pp.20140011-20140011

09/2014

DOI: 10.1259/bjr.20140011

PMCID: PMC4453136

PMID: 24999081

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Abstract

The incidence of spinal infections has increased in the past two decades, owing to the increasing number of elderly patients, immunocompromised conditions, spinal surgery and instrumentation, vascular access and intravenous drug use. Conventional MRI is the gold standard for diagnostic imaging; however, there are still a significant number of misdiagnosed cases. Diffusion-weighted imaging (DWI) with a b-value of 1000 and apparent diffusion coefficient (ADC) maps provide early and accurate detection of abscess and pus collection. Pyogenic infections are classified into four types of extension based on MRI and DWI findings: (1) epidural/paraspinal abscess with spondylodiscitis, (2) epidural/paraspinal abscess with facet joint infection, (3) epidural/paraspinal abscess without concomitant spondylodiscitis or facet joint infection and (4) intradural abscess (subdural abscess, purulent meningitis and spinal cord abscess). DWI easily detects abscesses and demonstrates the extension, multiplicity and remote disseminated infection. DWI is often a key image in the differential diagnosis. Important differential diagnoses include epidural, subdural or subarachnoid haemorrhage, cerebrospinal fluid leak, disc herniation, synovial cyst, granulation tissue, intra- or extradural tumour and post-surgical fluid collections. DWI and the ADC values are affected by susceptibility artefacts, incomplete fat suppression and volume-averaging artefacts. Recognition of artefacts is essential when interpreting DWI of spinal and paraspinal infections. DWI is not only useful for the diagnosis but also for the treatment planning of pyogenic and non-pyogenic spinal infections.

Magnetic Resonance Imaging

Spinal Cord Diseases - diagnosis

Diagnosis, Differential

Humans

Middle Aged

Abscess

Male

Decompression, Surgical

Suppuration - diagnosis

Joint Diseases - diagnosis

Discitis - diagnosis

Epidural Abscess - surgery

Female

Zygapophyseal Joint

Aged

Epidural Abscess - diagnosis

Diffusion Magnetic Resonance Imaging - methods

Details

Title: Subtitle: Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections
Creators: T Moritani - 1 Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
J Kim
A A Capizzano
P Kirby
J Kademian
Y Sato
Resource Type: Journal article
Publication Details: British journal of radiology, Vol.87(1041), pp.20140011-20140011
DOI: 10.1259/bjr.20140011
PMID: 24999081
PMCID: PMC4453136
NLM abbreviation: Br J Radiol
ISSN: 0007-1285
eISSN: 1748-880X
Publisher: England
Language: English
Date published: 09/2014
Academic Unit: Radiology; Stead Family Department of Pediatrics; Pathology
Record Identifier: 9984051596602771

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