Abstract
On magnetic resonance (MR) imaging, Modic type 1 (MT1) endplate changes and infectious spondylodiscitis share similar findings. Therefore, this study investigated vertebral bone marrow and endplate changes to enable their differentiation. The lumbar spine MR examinations of 91 adult patients were retrospectively included: 39 with MT1; 19 with early spondylodiscitis without abscess; and 33 with advanced spondylodiscitis with abscess. The assessment included percentage of bone marrow edema on sagittal short tau inversion recovery images, and the signal ratio of edema to unaffected bone and endplate contour (normal; irregular, yet intact; blurred; destructive) on sagittal unenhanced T1-weighted images. Differences were tested for statistical significance by Chi-square test and mixed model analysis of variance. The MR diagnostic accuracy in differentiating MT1 and spondylodiscitis was assessed by cross-tabulation and receiver-operating characteristic analysis. The endplate contours, edema extents, and T1-signal ratios of MT1 (extent, 31.96%; ratio, 0.83) were significantly different (p < 0.001) from early spondylodiscitis (56.42%; 0.60), and advanced spondylodiscitis (91.84%; 0.61). The highest diagnostic accuracy (sensitivity, 94.87%; specificity, 94.23%; accuracy, 94.51%) in identifying MT1 was provided by an irregular, yet intact endplate contour. This may be a useful MR feature for the differentiation between MT1 and spondylodiscitis, particularly in its early stage.
Highlights
Modic type 1 (MT1) vertebral endplate changes have been controversial findings since first defined in the late 1980s to describe endplate degeneration and subchondral bone marrow edema on magnetic resonance (MR) imaging [1,2,3]
At 3.0 Tesla state-of-the-art spinal MR imaging, this study systematically investigated imaging features for the differentiation between MT1 and early and advanced spondylodiscitis, all presenting with bone marrow edema
The vertebral bone marrow edema extent was evaluated by using fat-suppressed, fluid-sensitive MR images, which have been shown to reveal more MT1 changes, compared to the standard T2-w images used for their original description [1,35]
Summary
Modic type 1 (MT1) vertebral endplate changes have been controversial findings since first defined in the late 1980s to describe endplate degeneration and subchondral bone marrow edema on MR imaging [1,2,3]. Bone marrow edema may correspond to endplate microfractures, accompanied by an increased vascularity [6,7,8]. This micro-environment may promote superimposed low-grade infections with Propionibacterium acnes and Corynebacterium propinquum [9,10,11,12,13,14,15]. MT1 might represent combined overloading, inflammation, and infection, which has drawn attention to a debate about its treatment, including the use of antibiotics, bisphosphonates, and therapeutic antibodies [16,17,18,19,20]
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