TY - JOUR
T1 - Can the pattern of vertebral marrow oedema differentiate intervertebral disc infection from degenerative changes?
AU - Shrot, S.
AU - Sayah, A.
AU - Berkowitz, F.
N1 - Publisher Copyright:
© 2017 The Royal College of Radiologists
PY - 2017/7
Y1 - 2017/7
N2 - Aim To evaluate whether various patterns of bone marrow oedema could be used to discriminate between infection and degenerative change. Materials and methods Seventy patients with imaging features suspicious for discitis and available clinical follow-up were blindly reviewed for vertebral marrow oedema on sagittal short-tau inversion recovery (STIR) images according to the following patterns: I, vertebra oedema is adjacent to the intervertebral space and sharply-marginated; II, vertebral oedema is adjacent to the intervertebral space but not sharply marginated from normal marrow or involves the entire vertebral body; and III, vertebral oedema is distant from the endplate with intervening hypointense marrow signal. Results Of 45 patients with a clinical diagnosis of discitis, pattern II was the most common oedema pattern (64%). Approximately 20% and 9% of discitis patients showed patterns I and III, respectively. In patients with degenerative changes, 44% patients showed pattern I, 32% showed pattern II, and 24% showed pattern III. Pattern II had a sensitivity, specificity, and positive predictive value of 0.64, 0.68, and 0.78 for diagnosing spine infection, respectively. Conclusions Although bone marrow oedema in infective discitis most often extends from the disc space and has indistinct margins, the oedema may also have sharp margins or be remote from the involved intervertebral space. Bone marrow oedema patterns of infective discitis overlap with those of degenerative disease and are not sufficiently reliable to exclude infection in cases with magnetic resonance imaging findings suggestive of discitis.
AB - Aim To evaluate whether various patterns of bone marrow oedema could be used to discriminate between infection and degenerative change. Materials and methods Seventy patients with imaging features suspicious for discitis and available clinical follow-up were blindly reviewed for vertebral marrow oedema on sagittal short-tau inversion recovery (STIR) images according to the following patterns: I, vertebra oedema is adjacent to the intervertebral space and sharply-marginated; II, vertebral oedema is adjacent to the intervertebral space but not sharply marginated from normal marrow or involves the entire vertebral body; and III, vertebral oedema is distant from the endplate with intervening hypointense marrow signal. Results Of 45 patients with a clinical diagnosis of discitis, pattern II was the most common oedema pattern (64%). Approximately 20% and 9% of discitis patients showed patterns I and III, respectively. In patients with degenerative changes, 44% patients showed pattern I, 32% showed pattern II, and 24% showed pattern III. Pattern II had a sensitivity, specificity, and positive predictive value of 0.64, 0.68, and 0.78 for diagnosing spine infection, respectively. Conclusions Although bone marrow oedema in infective discitis most often extends from the disc space and has indistinct margins, the oedema may also have sharp margins or be remote from the involved intervertebral space. Bone marrow oedema patterns of infective discitis overlap with those of degenerative disease and are not sufficiently reliable to exclude infection in cases with magnetic resonance imaging findings suggestive of discitis.
UR - http://www.scopus.com/inward/record.url?scp=85013175393&partnerID=8YFLogxK
U2 - 10.1016/j.crad.2017.01.010
DO - 10.1016/j.crad.2017.01.010
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C2 - 28233518
AN - SCOPUS:85013175393
SN - 0009-9260
VL - 72
SP - 613.e7-613.e11
JO - Clinical Radiology
JF - Clinical Radiology
IS - 7
ER -