Imaging Findings of Spondylodiscitis

Spondylodiscitis is an infection of the intervertebral disc and adjacent vertebral bodies. Magnetic resonance imaging is the method of choice for the spondylodiscitis. The characteristic findings in the spondylodiscitis are hypointense on T1-weighted (W) image and hyperintense on T2W and fat-saturation T2W images, contrast enhancement on contrast- enhanced T1W with fat saturation images in the disc space and adjacent vertebral bodies, and phlegmon or abscess of the paraspinal soft tissues and epidural space. Phlegmon shows homogenous contrast enhancement, while abscess shows peripheral ring-enhancement on contrast- enhanced T1W with fat saturation images. Differentiation of tuberculous, brucellar and pyogenic spondylodiscitis is radiological difficult. Features that also favor tuberculosis infection include multilevel disease, large paravertebral abscess, meningeal involvement and subligamentous spread. Brucellar spondylodiscitis most commonly affects the lumbar spine. Bone destruction is less severe than in tuberculous spondylodiscitis. Osteophyte formation at the anterior vertebral endplate is typical.

Spondilodiskit intervertebral disk ve komşu vertebranın enfeksiyonudur. Manyetik rezonans görüntüleme spondilodiskitte tercih edilen yöntemdir. Spondilodiskitin karakteristik bulguları diskte ve komşu vertebralarda T1ağırlıklı (A) görüntüde hipointens, T2A ve yağ baskılamalı T2A görüntüde hiperintens ve kontrastlı görüntülerde kontrastlanma, paravertebral yumuşak doku ve epidural mesafede abse ya da flegmonun izlenmesidir. Flegmon homojen boyanırken, abse peripheral ring tarzında boyanma gösterir. Tuberküloz, brusellar ve piyojenik spondilodiskitleri radyolojik olarak ayırt etmek zordur. Tuberküloz spondilodiskitte multipl seviye tutulumu, büyük paravertebral abse, meningeal tutulum ve subligamentöz yayılım izlenir. Brusellar spondilodiskit en çok lomber bölgeyi tutar. Kemik destrüksiyonu tuberkülozdan daha az şiddetlidir. Anterior vertebral endplatoda izlenen osteofit tipiktir.