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“Pseudodiskitis”: Degenerative Disc Disease Mimicking Diskitis 2003

Lee H.J, Cheng P.N, Ho T. Z.
University Hospital, New Jersey Medical School,
Newark, NJ.

Purpose
Neck or back pain is a common yet nonspecific clinical symptom. MRI examination of the spine without contrast is the standard imaging evaluation for the back pain. The MRI manifestation of degenerative disc disease may mimic diskitis and has been described but not been emphasized. Recognition of this atypical radiographic pattern may alter the clinical management.

Materials and Methods
Five patients including one cervical spine, one thoracic spine and three lumbar spine were in the study. Age ranges from 52 to 74 year-old. MRI of the spine was performed in sagittal and axial planes without and with Gadolinium administration.

Results
The disc space was decreased and the signal intensity was increased on T2 weighted images. The adjacent vertebral cortical endplates showed irregularity and hypersignal intensity change on T2 weighted images. Contrast enhancement of annulus and cortical endplates was seen in all cases. The findings mimic that of diskitis and osteomyelitis. Conventional imaging of the spine revealed no evidence of bone destruction. Two patients underwent CT guided Needle biopsy. One case showed calcium pyrophosphate dihydrate deposition, the other case showed fibrous tissue.

Conclusion
MR imaging has become the procedure of choice for screening patients for disc disease and often is the only imaging study for workup back pain. Annular tears as well as diskitis can be seen on MRI as increased signal intensity within the disc on T2 weighted images and enhanced on T1 weighted with Gd-DTPA images. It is critical to recognize MRI findings of degenerative disc disease can mimic that of diskitis. It is important to review the conventional radiography and laboratory results together with MR imaging before the patient to have any further invasive procedures or even surgical interventions.

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Presenting author: Huey-Jen Lee, M.D. member of ARRS.
The paper has been previously presented in the 39th ASNR Annual Meeting.