Jong Won Kwon MD, Abstract Co-Author: Nothing to Disclose

Sang-Hee Choi MD, Presenter: Nothing to Disclose

Young Cheol Yoon, Abstract Co-Author: Nothing to Disclose

Jee Young Jung, Abstract Co-Author: Nothing to Disclose

To evaluate magnetic resonance (MR) imaging findings for the differentiation of Modic type I change from early infectious spondylitis in the lumbar spine.

MR images of lumbar spine obtained in 25 consecutive patients (14 men, 11 women) with bone marrow changes adjacent to the endplates of decreased signal intensity (SI) on T1-weighted images and increased SI on T2-weighted images were systematically evaluated by two observers. Spinal infections with rim-enhancing abscesses were excluded. Sharpness of margin of signal change in the affected vertebral bodies, presence of erosion or destruction of endplate on T1-weighted images, SI and enhancement in the intervertebral discs, and soft tissue change of perivertebral and epidural area were evaluated. Patient charts were reviewed and final diagnoses were confirmed.

Final diagnoses were 14 cases of Modic type I change and 11 cases of early infectious spondylitis. Margin of signal change was sharp in 3 cases of infectious spondylitis and 10 cases of Modic change. The remained showed blurred margin (p = 0.028). Endplates showed 2 erosions and 9 destructions in infectious spondylitis, and 11 erosions and 1 destruction in Modic change (p = 0.01). Intervertebral discs showed hyperintensities on T2-weighted images in 9 cases of infectious spondylitis and 10 cases of Modic change (p = 0.661). Intervertebral discs were enhanced in 8 cases of infectious spondylitis and 11 cases of Modic change (p = 1.00). Perivertebral soft tissue changes with more than 1 cm thickness were seen 2 cases in each (p = 1.00) and epidural soft tissue changes were seen 4 cases and 1 case in infectious spondylitis and Modic change, respectively (p = 0.133)

The most useful findings of Modic type I change for the differentiation from early infectious spondylitis are endplate erosion without destruction on T1-weighted images and sharp margin of areas of marrow signal changes.

Sharpness of margin of signal changes and destruction of endplates were reliable diagnostic clues for the differentiation between Modic type I changes and early infectious spondylitis.

Kwon, J, Choi, S, Yoon, Y, Jung, J, Modic type I Change versus Early Infectious Spondylitis: Diagnostic Clues for the Differentiation.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5005907.html