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Differentiation of Pyogenic Osteomyelitis from Modic type 1 Degenerative Endplate Changes 2013

Category General Spine Benjamin Cornwell, DO
Jack Lake, DO
Joel Thomas, MD
Purpose Differentiation of early acute pyogenic endplate osteomyelitis and Modic type 1 degenerative endplate changes can be difficult given there similar imaging characteristics. The goal of this poster will be to emphasize the differences between these two entities. Materials & Methods 1. Discuss the pathophysiology of pyogenic vertebral osteomyelitis and Modic type 1 degenerative endplate changes. 2. Review multiple cases of acute pyogenic endplate osteomyelitis and Modic type 1 degenerative endplate changes. 3. Correlate spinal illustrations and MR images of the two pathologic processes. Results Differences between pyogenic osteomyelitis and Modic type 1 degenerative endplate changes.

Pyogenic osteomyelitis

Modic type 1 degenerative endplate changes

Increased signal in adjacent disk

+/-

-

Endplate destruction

+/-

-

Endplate decreased T1 signal

+

+

Endplate increased T2 signal

+

+

Endplate postcontrast enhancement

+

+/-

Paraspinal soft tissue involvement

+/-

-

Vacuum disk phenomenon

-

+/-

Conclusion Differentiation of pyogenic osteomyelitis from Modic type 1 degenerative endplate changes on MR is possible in the majority of cases.  However some cases cannot be confidently differentiated and clinical correlation and/or MR follow-up is necessary. This poster reviews the major differences between pyogenic osteomyelitis and Modic type 1 degenerative endplate changes. References 1. MR Imaging Assessment of the Spine: Infection or an Imitation? Sung Hwan Hong, MD, et al.  Radiographics 2009; 29:599–612. 2. MR Imaging findings in spinal infections: Rules or myths? Ledermann et al.  Radiology 2003, 228: 506-514. 3. Yousem, Y.M., & Grossman R.I. (2010). Neuroradiology: The Requisites.  Philadelphia, PA: Mosby. 4. Ross, J.S., & Moore K.R. (2010). Diagnostic Imaging: Spine. Altona, Canada: Amirsys.