Skip to main content

Table 2 Common MRI features in spondylodiscitis and mimicking diseases

From: Spinal disorders mimicking infection

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

 

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

  

Compression fracture

-

Edema fracture line

Normal

Absence of epidural and soft tissue abscesses

  

Acute Schmorl node

Thoracolumbar

High signal T2 and STIR, enhancement, concentric ring feature, one endplate

No disc abnormality

  Â