31 March 2024: Review Articles
Differentiation of Native Vertebral Osteomyelitis: A Comprehensive Review of Imaging Techniques and Future Applications
Weijian Zhu 12BCEF , Sirui Zhou 3D , Jinming Zhang 1D , Li Li 4B , Pin Liu 2A , Wei Xiong 1A*DOI: 10.12659/MSM.943168
Med Sci Monit 2024; 30:e943168
Introduction
Segmental Structure of the Spine
Diagnostic Value of Plain Radiographs and Computed Tomography for NVO
Diagnostic Value of MRI in NVO
Pyogenic Spondylitis
Tuberculous Spondylitis
Brucellar Spondylitis
Fungal Spondylitis
Diagnostic Value of Positron Emission Tomography for NVO
Artificial Intelligence Applications and the Future
Conclusions
References
Table 4 Characterization of common NVO types.
| NVO type | Early stage | Terminal | ||||
|---|---|---|---|---|---|---|
| Plain radiograph | CT | MRI | plain radiograph | CT | MRI | |
| PS | Decreased intervertebral space height, bone defects ()Figure 3A | Diffuse increase in signal in the affected vertebrae, decrease in the height of the intervertebral space, and partial osteolysis ()Figure 3B, 3C | Diffuse enhancement of the infected vertebral body on T2WI imaging, disc erosion, and increased susceptibility of the infection to spread to the epidural space ()Figure 3D | Loss of intervertebral space height, vertebral bone defects, vertebral body slippage, etc. ()Figure 4A | Abnormal signal shadowing near the calcaneus, involvement of 2 or fewer vertebrae, reduced intervertebral space height, localized bone loss, possible slip of the spine ()Figure 4B, 4C | Poorly demarcated anomalous signal in the paravertebral area, abnormal signal shadows near the lesser joints, thick and irregular walled abscesses, involvement of 2 or fewer vertebrae ()Figure 4D |
| TS | Bone defect near endplate ()Figure 5A | Localized bone loss around the endplate, possible formation of bone abscesses, uneven signal enhancement in infected vertebrae ()Figure 5B | The infected vertebral body showed heterogeneous enhancement on T2WI imaging, and the endplate showed localized severe bone destruction ()Figure 5C, 5D | Severe bone loss, loss of intervertebral space height, spinal deformity ()Figure 6A | Severe bone loss, loss of intervertebral space height, spinal deformity, involvement of posterior elements, jumping distribution of infected vertebrae, decreased signal value of localized bone infection due to calcification ()Figure 6B | Severe disruption of the endplate margins with osteolysis, localized formation of calcified bone without regenerative bone formation, spread of the abscess by sublimation involving three or more vertebrae, more likely to form a paravertebral abscess, thin and smooth walled abscess (less than 2 mm), lesion unevenly enhanced. A spinal deformity is present, involving the posterior elements ()Figure 6C, 6D |
| BS | Decreased intervertebral space height | Inflated disc sign, decreased intervertebral space height, increased signal from infected vertebrae, and diffusion throughout the vertebral body | Diffuse high signal in the infected vertebral body with reduced intervertebral space height on T2WI images | Reduced height of the intervertebral space, severe shadowing of the vertebral body margins, or even bone defects ()Figure 7A | Loss of intervertebral space height, slight bone destruction at the margins of the infected vertebrae, diminished signal relative to the acute phase, and diffusion throughout the vertebral body ()Figure 7B | Infection occurs mainly in the lower lumbar spine, where the vertebral bone is relatively well preserved and periarticular destruction is more limited. The T2WI signal values of the intervertebral disc and vertebral bone are lower than those of the water ()Figure 7C, 7D |
| FS | No special findings ()Figure 8A | Localized abnormal signals in infected vertebrae ()Figure 8B | In T2WI, abscessed and infected vertebrae show a high signal loss, a low signal band under the endplate, and a 50% probability of elevated disc signals ()Figure 8C, 8D | Localized bone destruction of the endplate with jumping lesions | Localized bony destruction of the endplates, discrete vertebrae are damaged, and abnormal signals are localized | Paravertebral abscesses on T2WI images show diffuse enhancement with enhanced borders and are associated with poliomyelitis, spinal cord cavernous disease, and extensive meningeal infection |
| NVO – native vertebral osteomyelitis; BS – brucellar spondylitis; FS – fungal spondylitis; T2WI – T2-weighted image; CT – computed tomography; MRI – magnetic resonance imaging. | ||||||