Discitis/Vertebral Body Osteomyelitis

Vertebral body osteomyelitis (and associated discitis) is an infection involving the vertebral body endplates that extends to the intervening disc space. While vertebral body endplate destruction may be visible on plain films or bone CT studies, MR is the preferred imaging modality to assess for spread of infection to the disc space and paraspinal tissues, or for development of an epidural abscess. T1W images (A, D) will show endplate destruction and thickening of the paraspinal tissues with ill-defined fat places. T2W images (B) will demonstrate high signal in the intervertebral disc. Gadolinium enhanced images (C) will demonstrate enhancement of the infected vertebral bodies and paraspinal tissues. In the presence of an epidural abscess fluid sensitive sequences will show a collection in the epidural space that demonstrates peripheral enhancement upon gadolinium administration. 


REFERENCES
Dagirmanjian A, Schils J, McHenry M, et al. MR imaging of vertebral osteomyelitis revisited. Am J Roentgenol 1996;167(6):1539-43.
Kowalski TJ, Layton KF, Berbari EF, et al. Follow-up MR imaging in patients with pyogenic spine infections: lack of correlation with clinical features. Am J Roentgenol 2007;28:693-99.