title: Can the pattern of vertebral marrow oedema differentiate intervertebral disc infection from degenerative changes?
abstract: OBJECTIVE
  To evaluate whether various patterns of bone marrow oedema could be used to discriminate between infection and degenerative change.
  
  
  METHODS
  Seventy patients with imaging features suspicious for discitis and available clinical follow-up were blindly reviewed for vertebral marrow oedema on sagittal short-tau inversion recovery (STIR) images according to the following patterns: I, vertebra oedema is adjacent to the intervertebral space and sharply-marginated; II, vertebral oedema is adjacent to the intervertebral space but not sharply marginated from normal marrow or involves the entire vertebral body; and III, vertebral oedema is distant from the endplate with intervening hypointense marrow signal.
  
  
  RESULTS
  Of 45 patients with a clinical diagnosis of discitis, pattern II was the most common oedema pattern (64%). Approximately 20% and 9% of discitis patients showed patterns I and III, respectively. In patients with degenerative changes, 44% patients showed pattern I, 32% showed pattern II, and 24% showed pattern III. Pattern II had a sensitivity, specificity, and positive predictive value of 0.64, 0.68, and 0.78 for diagnosing spine infection, respectively.
  
  
  CONCLUSIONS
  Although bone marrow oedema in infective discitis most often extends from the disc space and has indistinct margins, the oedema may also have sharp margins or be remote from the involved intervertebral space. Bone marrow oedema patterns of infective discitis overlap with those of degenerative disease and are not sufficiently reliable to exclude infection in cases with magnetic resonance imaging findings suggestive of discitis.
authors.affiliation: Division of Neuroradiology, Department of Radiology, Medstar Georgetown University Hospital, Washington, DC, USA. Electronic address: shaishrot@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Shrot
authors.affiliation: Division of Neuroradiology, Department of Radiology, Medstar Georgetown University Hospital, Washington, DC, USA.
authors.forename: A
authors.initials: A
authors.lastname: Sayah
authors.affiliation: Division of Neuroradiology, Department of Radiology, Medstar Georgetown University Hospital, Washington, DC, USA.
authors.forename: F
authors.initials: F
authors.lastname: Berkowitz
mesh_terms: D003937:Diagnosis, Differential; D015299:Discitis / Q000000981:diagnostic imaging* / Q000382:microbiology*; D004487:Edema / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging*