title: Atypical findings on magnetic resonance imaging in the patients with active pyogenic spondylitis in Japanese university hospitals.
abstract: Recently, aging population and immuno-compromised patients have been rising in Japan. Accordingly, patients with pyogenic spondylitis have been increasing and may present atypical clinical features. University hospitals treat many elderly patients and patients with poor general condition. Therefore, patients with pyogenic spondylitis treated at two university hospitals were retrospectively investigated to clarify the recent clinical and radiologic characteristics of this infection. There were 30 patients (average age: 68 years) treated in two university hospitals between 2009 and 2010. The onset was acute or subacute in 15 patients, insidious in 7 and unclassified in 8. Culture tests were performed in 25 patients, and the causative microorganisms were identified in 20 patients with the identification rate of 80%, including 4 patients infected by methicillin-resistant staphylococci. Classically, active pyogenic spondylitis is characterized by typical findings on magnetic resonance imaging (MRI): obvious signal decrease in T1-weighted image (WI) and increase in T2WI with contrast enhancement found in most of the bodies of two adjacent vertebrae and the intervening intervertebral disc. Among 29 patients with active pyogenic spondylitis, whose lesions were not in the healing stage, 16 patients demonstrated at least one of the atypical MRI findings; 9 patients showed involvement ≥ 3 vertebrae or only 1 vertebra, 5 showed the signal changes of the lesions involving small, spotty, or faint areas, and 3 showed small vertebral lesions but larger epidural or paraspinal abscesses. In conclusion, currently, about half of the patients with pyogenic spondylitis demonstrate atypical MRI findings in the university hospitals in Japan.
authors.affiliation: Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan. toshi-7@ra2.so-net.ne.jp
authors.forename: Toshimi
authors.initials: T
authors.lastname: Aizawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ozawa
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Koakutsu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakamura
authors.forename: Haruo
authors.initials: H
authors.lastname: Kanno
authors.forename: Toru
authors.initials: T
authors.lastname: Hirano
authors.forename: Atsuki
authors.initials: A
authors.lastname: Sano
authors.forename: Takui
authors.initials: T
authors.lastname: Ito
authors.forename: Eiji
authors.initials: E
authors.lastname: Itoi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D002097:C-Reactive Protein / Q000378:metabolism; D020802:Epidural Abscess / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D007958:Leukocyte Count; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013131:Spine / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D013166:Spondylitis / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging
chemical_list: D002097:C-Reactive Protein