Radiologic Diagnosis of Spondylodiscitis, Role of Magnetic Resonance

INTRODUCTION: Study aim is to report the Magnetic Resonance Imaging (MRI) features of acute and chronic spontaneous spondylodiscitis. CASE REPORT: 57 year old female, complaining of a fever and longstanding cervical pain worsened during physical therapy. METHODS: MR images were acquired using superconductive magnet 1.5 T, with the following sequences: sagittal PD and T2 TSE, sagittal T1 SE, axial PD and T2 TSE (lumbar spine), axial T2 GRE (cervical spine). Axial and sagittal T1 SE after administration of (gadolinium DTPA). Examination was reviewed by three radiologists and compared to CT findings. RESULTS: Patient reported cervical pain associated with fever and minimal weight loss. Blood tests were normal except hyperglycemia (DM tip II). X Ray: vertebral destruction localized at C-4 and C-5: NECT: destruction of the C-4/C-5 vertebral bodies (ventral part). MRI: Low signal of the bone marrow on T1l images, which enhanced after Gd-DTPA administration and became intermediate or high on T2 images. The steady high signal intensity of the disk on T2 images and enhancement on T1 images is typical for an acute inflammatory process. Bone Scintigrafi results: Bone changes suspicious for metastasis. Whole body CT results: apart from spine, no other significant changes. CONCLUSION: MRI is the most sensitive technique for the diagnosis of spondylodiscitis in the acute phase and comparable to CT regarding chronial stage of the disease. The present imagining essay os aimed at showing the main magnetic resonance imaging findings of tuberculous discitis.