Info

Epidural Scar

Recurrent Disc

Epidural location

Follows line of surgery

Opposite disc space

Mass effect

Conforms to space, retracts dura

Compresses, displaces dura

Signal intensity

Hypo- or isointense on T1WI

Hypo- or intermediate intensity on T1WI

Gadolinium

Enhances

Does not enhance centrally, may enhance peripherally

Adapted from McCulloch JA, Transfeldt EE: Macnab'sBachache, 3rd edition, Williams and Wilkins, 1997, p. 719.

Adapted from McCulloch JA, Transfeldt EE: Macnab'sBachache, 3rd edition, Williams and Wilkins, 1997, p. 719.

Arachnoiditis can be well visualized on MRI. There are three most common patterns typical of arachnoiditis: (1) central clumping of nerve roots (Figure 17-16), (2) adherence of the nerve roots to the dura giving an empty sac appearance, and (3) nonvisualization of roots because of an increased T1 intradural signal complicating the differentiation between CSF and neural structures.

Postoperative spondylodiscitis is characterized by the loss of the normal outline of the vertebral endplates with low signal intensity of the bone marrow on T1WI and high signal intensity on T2WI (Figure 17-17A). Contrast enhancement of the disc, the adjacent endplates, and the surrounding paravertebral soft tissue and epidural space make the diagnosis of pyogenic vertebral osteomyelitis almost certain. MRI is also useful in monitoring response to antibiotic treatment of the infection, in conjunction with ESR and CRP levels. The differential diagnosis of disc space infection is type I Modic changes in which low signal intensity appears in the disc on T2WI. In cases in which discec-

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