Schwarz-Nemec Ursula, Friedrich Klaus M, Stihsen Christoph, Schwarz Felix K, Trattnig Siegfried, Weber Michael, Grohs Josef G, Nemec Stefan F
Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, A-1090 Vienna, Austria.
Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, A-1090 Vienna, Austria.
J Clin Med. 2020 Mar 18;9(3):826. doi: 10.3390/jcm9030826.
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 ( < 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.
在磁共振成像（MR）中，Modic 1型（MT1）终板改变与感染性脊椎椎间盘炎有相似表现。因此，本研究对椎体骨髓和终板改变进行了调查，以便对它们进行鉴别。回顾性纳入了91例成年患者的腰椎MR检查：39例为MT1；19例为早期无脓肿的脊椎椎间盘炎；33例为晚期有脓肿的脊椎椎间盘炎。评估包括矢状面短Tau反转恢复图像上骨髓水肿的百分比，以及矢状面未增强T1加权图像上水肿与未受影响的骨骼和终板轮廓（正常；不规则但完整；模糊；破坏）的信号比。通过卡方检验和方差混合模型分析检验差异的统计学意义。通过交叉表和受试者操作特征分析评估MR鉴别MT1和脊椎椎间盘炎的诊断准确性。MT1的终板轮廓、水肿范围和T1信号比（范围，31.96%；比率，0.83）与早期脊椎椎间盘炎（56.42%；0.60）和晚期脊椎椎间盘炎（91.84%；0.61）有显著差异（<0.001）。识别MT1的最高诊断准确性（敏感性，94.87%；特异性，94.23%；准确性，94.51%）由不规则但完整的终板轮廓提供。这可能是鉴别MT1和脊椎椎间盘炎的一个有用的MR特征，特别是在早期阶段。
