Article Figures & Data
Figures
- Fig 1.
A 42-year-old man experienced low-back pain and fever for 5 days. A and B, Axial T1-weighted (TR/TE, 600/16) (A) and axial T2-weighted (TR/TE, 4900/111) (B) MR images show an intraosseous lesion of T1-weighted low signal intensity and T2-weighted high signal intensity with an inner rim sign and an outer halo sign (arrow) near the upper endplate of S1. Note the limited amount of epidural soft-tissue inflammation (arrowhead).
- Fig 2.
A 46-year-old woman with fever for 2 days. A and B, Sagittal T1-weighted (TR/TE, 550/12) (A) and sagittal STIR (TR/TE/TI, 3130/65/160) (B) MR images show multiple intraosseous lesions of T1-weighted low signal intensity and STIR high signal intensity. Note some osseous lesions with a positive halo sign (arrows) and the absence of paraspinal or epidural inflammatory soft tissue. C, Sagittal T1-weighted (TR/TE, 550/12) follow-up MR image obtained 12 months later shows gradually reconstituted fatty marrow with a decrease in the number and extent of infectious foci. Note a peripheral rim of increased signal intensity (arrow) in a residual subchondral lesion of low signal intensity at the lower endplate of L5.
- Fig 3.
A 56-year-old man with fever for 1 week. A, Sagittal T1-weighted (TR/TE, 550/12) MR image shows multiple intraosseous lesions of low signal intensity involving the bodies and posterior elements of the vertebrae superimposed on the diffuse abnormal-signal-intensity marrow. Note an osseous lesion with a positive rim sign (arrow) at the T11 vertebra. B, Sagittal T1-weighted (TR/TE, 700/12) fat-suppressed contrast-enhanced MR image reveals global enhancement of intraosseous lesions (arrows). Note the absence of paraspinal or epidural inflammatory soft tissue. C, Sagittal T1-weighted (TR/TE, 700/12) fat-suppressed contrast-enhanced follow-up MR image obtained 5 months later shows an increase in extent, signal-intensity abnormality, and enhancement of T11, L1, L3, and apparently new L4 lesions (arrows) as well as a decrease in the extent of the L2 lesion (arrowhead). D, Sagittal T1-weighted (TR/TE, 700/12) follow-up MR image obtained 25 months later reveals almost complete reconstitution of fatty marrow in previously affected bone.
Tables
- Table 1:
Demographic data, histopathologic findings, and culture results in 7 patients with unusual manifestations of vertebral osteomyelitis
Patient No. Sex/Age (yr) Biopsy Sites and Histopathologic Findings Culture Results of Microorganisms 1 M/53 CT-guided bone biopsy, L5 vertebra: chronic osteomyelitis Bone: gram-positive cocci Blood: S aureus 2 M/42 CT-guided bone biopsy, S1 upper endplate: chronic osteomyelitis Bone: (−) Blood: (−) 3 M/80 CT-guided bone biopsy, L1 vertebra: chronic osteomyelitis Bone: (−) Blood: (−) 4 F/46 CT-guided bone biopsy, T11 vertebra: chronic osteomyelitis Bone: (−) Blood: Salmonella organisms 5 M/56 CT-guided bone biopsy, T11 vertebra: chronic osteomyelitis Bone: (−) Blood: (−) 6 F/53 CT-guided bone biopsy, L3 vertebra: chronic osteomyelitis, skin biopsy, shoulder: mycobacterial infection Bone: (−) Blood: (−) 7 M/66 CT-guided bone biopsy, L3 vertebra: chronic fibrosis, lymph node biopsy, neck: mycobacterial infection Bone: (−) Blood: (−) Note:—(−) indicates negative.
- Table 2:
MR imaging findings in 7 patients with unusual manifestations of vertebral osteomyelitis
Patient No. Involved Bones* Intraosseous Lesions SI of Intraosseous Lesions Enhancement of Intraosseous Lesions Rim Sign Halo Sign Preservation of Intervertebral Disks Soft-Tissue Inflammation† T1W T2W STIR 1 Spine (L5) Solitary ↓ −− or ↑ ↑ Global Yes Yes Yes Yes 2 Spine (S1) Solitary ↓ ↑ ↑ Global Yes Yes Yes Yes 3 Spine (T10, L1, upper sacrum) Multiple ↓ ↑ ↑ Global Yes Yes Yes Yes 4 Spine (T5-L5, upper sacrum), bilateral pelvic girdles Multiple ↓ −− or ↑ ↑ Global or marginal No Yes Yes Yes 5 Spine (whole spine), bilateral ribs Multiple ↓ −− or ↑ ↑ Global Yes Yes Yes No 6 Spine (whole spine) Multiple ↓ −− or ↑ ↑ Global or marginal Yes Yes Yes Yes 7 Spine (whole spine), bilateral ribs, sternum, bilateral pectoral girdles, bilateral pelvic girdles Multiple ↓ −− or ↑ ↑ Global or marginal Yes Yes Yes Yes Note:—SI indicates signal intensity; T1W, T1-weighted MR images; T2W, T2-weighted MR images; STIR, short τ inversion recovery; ↑, hyperintense; −−, isointense; ↓, hypointense.
* Posterior element involvement of the vertebrae is noted in 3 patients (patients 5–7).
† Limited amount of the paraspinal or epidural inflammatory tissue is noted in 6 patients (patients 1–4, 6, and 7).
- Table 3:
Therapy, follow-up MR imaging studies, and clinical outcome in 7 patients with unusual manifestations of vertebral osteomyelitis
Patient No. Therapy Interval between Initial and Subsequent MRI (months) Sequential Change between Initial and Last MRI Clinical Outcome after Treatment 1 Antibiotic 2 Healing Improved 2 Surgical debridement and antibiotic 5 Healing Improved 3 Antibiotic 4 Healing Improved 4 Antibiotic 3, 8, 12 Healing Improved 5 Antibiotic and anti-TB 5, 10.5, 25 Almost healed Cured 6 Antibiotic and anti-TB 6.5 Healing Improved 7 Antibiotic and anti-TB 7 Healing Improved Note:—MRI indicates MR imaging; TB, tuberculosis.
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