E. Turgut Tali MD, Presenter: Nothing to Disclose

1) Identify the imaging findings of spinal infections. 2) Analyze imaging and therapeutic techniques and apply this knowledge to protocol development, patient management/safety, and cost. 3) Compare indications and contraindications of specific image-guided procedures. 4) Improve basic knowledge and skills relevant to clinical practice.

Spinal infection is a significant cause of morbidity and mortality. This entity is notoriously difficult to differentiate clinically from degenerative processes, noninfective inflammatory disorders, and spinal neoplasm. MRI is modality of choice for the spinal infections. Low signal areas and interruption of the cortical continuity, destruction of the cortical margins are typical on T1WI whereas high signal of affected areas of the vertebral body and disc is typical on T2WI for the spondylodiscitis. Contrast enhancement is the earliest sign and pathognomonic in the acute inflammatory episode and even subtle infection then persists to a varying degree for several weeks or months. Recent epidemiologic studies point to an increasing prevalence of spinal epidural infection. MRI demonstrates soft tissue mass within the epidural space encroaching upon the theca or spinal nerves. Frequently, long segment iso-hyperintense epidural mass lesion with hypointense thickened, displaced dura on T1- and T2WI is observed. Pyogenic leptomeningitis is the most common bacterial infection of the spinal axis. On MRI, the precontrast T1WI may be either normal or may reveal nonspecific abnormalities. T2WI are of limited use since the signal intensity of CSF may obscure the meningeal structures. Postcontrast T1WI may show inflamed dura or nerve sheath with possible involvement of the spinal cord. Infection of the spinal cord is relatively rare. MRI findings of myelitis may differ in a wide spectrum from mild edema, swelling with mild or no contrast enhancement to prominent edema and abscess formation with diffuse, patchy or ring enhancement.  

Tali, E, Spinal Infections.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000959.html