Utility of MRI in the follow-up of pyogenic spinal infection in children.
BACKGROUND
MRI is used at an increasing rate in evaluation of pediatric spinal infections both at the time of diagnosis and in follow-up. However, the impact of MRI in follow-up has been rarely evaluated to date.


OBJECTIVE
To evaluate serial follow-up spinal MRI changes compared to clinical outcome and assess their impact on clinical management.


METHODS
All pediatric (<18 years) patients with pyogenic spinal infection over a 9-year period with at least one follow-up after treatment were included. Atypical infections were excluded.


RESULTS
We examined 35 whole-spine and 16 localized spinal scans from 17 patients (2 months to 16 years, 9F:8 M) who had 51 follow-ups done 2 weeks to 4.75 years after baseline. Seven children (41%) younger than 3 years underwent 33 follow-ups (65%); most required GA or sedation. Short-term follow-up scans demonstrated epidural and/or paraspinal soft-tissue changes correlating with clinical status and laboratory findings in all cases. However, MRI showed that bone and/or disc abnormalities continued and progressed in some cases despite clinical improvement. Long-term follow-up scans showed bone, disc and soft-tissue changes 1-3 years after baseline, despite children being symptom free. Extension of antibiotics occurred in 47% of children partly based on follow-up MRI.


CONCLUSIONS
Epidural and paraspinal soft-tissue changes correlated with children's clinical symptoms. Progression of bone and disc changes can manifest despite adequate clinical response. Long-term or serial routine follow-ups were not necessary. Management should be made based on clinical response.
Wang
Qiuyan
Q
Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, M5G 1X8, ON, Canada. wangqiuyan8888@yahoo.com.cn
Babyn
Paul
P
Branson
Helen
H
Tran
Dat
D
Davila
Jorge
J
Mueller
Edrise L
EL
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013131:Spine / Q000473:pathology*; D013166:Spondylitis / Q000175:diagnosis*