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Disk Infection Versus Inflammatory/Degenerative Changes
A 58-year-old man with a history of heavy alcohol use, gastrointestinal bleeding, and prior bowel resection presenting with low back pain. FS, fat saturated; Sag, sagittal.
A 36-year-old man, who has had a previous diskectomy, presenting with low back pain. FS, fat saturated; Sag, sagittal.
A 42-year-old woman presenting with back pain of several months duration. FS, fat saturated; Sag, sagittal.
DESCRIPTION OF FINDINGS
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Case A: At the L3/L4 level prominent, T2 hyperintense signal is present in the disk space, with enhancement of the disk periphery, erosion of enhancing adjacent endplates, and phlegmonous paraspinal and psoas muscle inflammation.
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Case B: At the L5/S1 level, edematous, enhancing endplate changes are present with mild T2 hyperintense signal and lack of central enhancement in the disk space. Enhancement is noted along the surgical tract, most likely representing postoperative granulation tissue.
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Case C: Visible are large prevertebral phlegmon, anterior subligamentous edema/enhancement, prominent vertebral marrow edema, and enhancement with relative preservation of the intervertebral disk.
Diagnosis
Case A
Bacterial diskitis/osteomyelitis
Case B
Postoperative edematous/inflammatory endplate changes
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