Entity | Localization | Endplates | Disc | Soft tissues | Associated features | Pattern XR/CT |
---|---|---|---|---|---|---|
Spondylodiscitis | Lumbar spine | Blurred endplates Diffuse hypersignal STIR in mirror Amorphous enhancement | Hypersignal (hot sign disc) | Heterogeneous paraspinalepidural abscesses | Â | Endplate defects without sclerosis |
Modic 1 | Lumbar spine | Irregular contours but intact endplates Ratio of edema on T1 confined to subchondral bone Mixed pattern with inflammation and fat Pseudo-sparing, ghost sign after contrast Crab’s claw sign on DWI and lower ADC | Absence of hypersignal on T2 and STIR (unless vacuum phenomenon) | Slight infiltration, no abscesses | Several levels | Irregular and pseudo-cystic endplates |
Crystal diseases | Cervical > lumbar > thoracic | Erosive and hyperintensity Enhancement | Hyperintensity | Inflammation of soft tissues | Tophi and pyrophosphate deposits on hyposignal T1 and T2 Involvement of facet joints | Dense masses (tophi or CCPD) in other disc or facet joints with erosive pattern DECT +  +  + (gout) |
Spondyloarthropathy | Thoracolumbar junction Mobile segment | Hypersignal with enhancement on hemispheric shaped pattern, Romanus lesion | Possible hypersignal on T2 and STIR, transdiscal fracture | No abscesses, no epiduritis | Several levels Chest wall and sacroiliac involvement Posterior extension of fracture | Syndesmophytosis Bone ankylosis Kyphotic deformity |
Neuropathic spine | Thoracolumbarlumbosacral | Advanced destruction | Advanced discitis, vacuum disc | Variable signal depending on amount of debris and edema fluid collection (excessive motion) | Involvement of facet joints, osseous debris, spondylolisthesis, joint disorganization | Hypertrophic osteophytosisspinal deformity |
SAPHO | Thoracolumbar | Erosions, sclerosis, and bony bridging Semicircular pattern of hyperintensity on STIR enhancement Hypointensity in the chronic phase | Disc narrowing Rarely hypersignal on T2 and STIR and T1 with contrast | Contiguous involvement Thickening and inflammation of spinal ligaments Posterior facet joints and spinous process Sterno-clavicular, sacro-iliac | Â | Â |
Compression fracture | - | Edema fracture line | Normal | Absence of epidural and soft tissue abscesses | Â | Â |
Acute Schmorl node | Thoracolumbar | High signal T2 and STIR, enhancement, concentric ring feature, one endplate | No disc abnormality | Â | Â | Â |