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Open AccessArticle

Vertebral Bone Marrow and Endplate Assessment on MR Imaging for the Differentiation of Modic Type 1 Endplate Changes and Infectious Spondylodiscitis

1
Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, A-1090 Vienna, Austria
2
Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, A-1090 Vienna, Austria
3
MR Center of Excellence, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, A-1090 Vienna, Austria
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(3), 826; https://doi.org/10.3390/jcm9030826 (registering DOI)
Received: 6 March 2020 / Accepted: 16 March 2020 / Published: 18 March 2020
(This article belongs to the Section Nuclear Medicine & Radiology)
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. View Full-Text
Keywords: magnetic resonance imaging; Modic type 1 changes; infectious spondylodiscitis; vertebral bone marrow edema; vertebral endplate magnetic resonance imaging; Modic type 1 changes; infectious spondylodiscitis; vertebral bone marrow edema; vertebral endplate
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Schwarz-Nemec, U.; Friedrich, K.M.; Stihsen, C.; Schwarz, F.K.; Trattnig, S.; Weber, M.; Grohs, J.G.; Nemec, S.F. Vertebral Bone Marrow and Endplate Assessment on MR Imaging for the Differentiation of Modic Type 1 Endplate Changes and Infectious Spondylodiscitis. J. Clin. Med. 2020, 9, 826.

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