Prospective evaluation of contrast-enhanced MR imaging after uncomplicated lumbar discography.
OBJECTIVE
Postdiscography infection is an uncommon complication. Magnetic resonance (MR) imaging is often the modality of choice for evaluating spinal infection. Discography entails disc access and fluid injection that could alter the baseline MR imaging appearance of the spine and be confounded for infection. Our purpose was to describe the MR imaging findings of the lumbar spine subsequent to uncomplicated discography and to determine if this may mimic infection.


METHODS
In a prospective cohort study of eight adults (age 22-64 years, mean 45 years) with 22 intradiscal injections, all subjects underwent routine unenhanced and contrast-enhanced MR imaging during the 2-3 week interval postdiscography. A subset of four returned for additional MR imaging during the 4-8 week interval postdiscography. MR images were reviewed for intradiscal, endplate, marrow, and epidural findings and then compared with prediscography examinations. Infection was excluded by clinical documentation.


RESULTS
Postdiscography MR imaging showed that almost all levels were similar to baseline prediscography examinations. No levels developed new vertebral marrow edema, fluid-like intradiscal signal, endplate irregularity, or epidural abnormality. Two subjects simulated potential discitis, but these findings were unchanged from prediscography and were related to prior surgery.


CONCLUSIONS
Uncomplicated lumbar spine discography does not cause MR imaging changes that simulate discitis.
Carrino
John A
JA
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Outpatient Center, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Room 5165, Baltimore, MD 21287, USA. jcarrin2@jhmi.edu
Swathwood
Todd C
TC
Morrison
William B
WB
Glover
J Michael
JM
D000328:Adult; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D015299:Discitis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007278:Injections, Spinal / Q000009:adverse effects; D007479:Iopamidol; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013995:Time
D003287:Contrast Media; D007479:Iopamidol