Modic Type 1 vs Tuberculous Spondylitis
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Transcript of Modic Type 1 vs Tuberculous Spondylitis
MMODICODIC TTYPEYPE 11 VSVS TTUBERCULOUSUBERCULOUS SSPONDYLITISPONDYLITIS
Modic Type 1 Tuberculous SpondylitisDefinition Degenerative vertebral endplate
and subchondral bone marrow changes which can be seen in MRI
Presentation of extrapulmonary tuberculosis that affects the spine
Predilection Mostly affect the lumbar spine Most commonly involves the thoracic spine and less often the lumbar spine
Etiology Normal age-related degenerative process
Hematogenous spread of tuberculosis infection from the lung
Pathogenesis Disruption and fissuring of endplates and formation of a fibrovascular granulation tissue within the adjacent marrow
Represent the inflammatory stage of degenerative disk disease and indicate an ongoing active degenerative process
In most cases starts in the anterior spine and soft tissues and progresses posteriorly.
Osteomyelitis and arthritis progressive bone destruction vertebral collpase and kyphosis
The spinal canal can be narrowed by abscesses, granulation tissue, or direct dural invasion, leading to spinal cord compression and neurologic deficits
Clinical Manifestation
Chronic and constant low back pain Chronic back pain, fever, weight loss, neurologic deficits
Imaging Rö: Lumbar fusion Segmental instability (sagittal
translation of 3 mm or more on dynamic flexion-extension films)
Rö: Lytic destruction of anterior portion
of vertebral body Increased anterior wedging Collapse of vertebral body
MRI (best method): Hypointense on T1-weighted
imaging (T1WI) and hyperintense on T2-weighted imaging (T2WI)
Areas of enhancement on contrast-enhanced images (show bone marrow edema and inflammation)
Lack of abnormally increased signal intensity of an associated disk on T2
No soft-tissue involvement Vacuum phenomenon within
severely degenerated disks
Reactive sclerosis on a progressive lytic process
Enlarged psoas shadow with or without calcification
CT Scan (best method): Irregular lytic lesions Sclerosis Disk collapse Soft-tissue abscesses and
calcification important because they are rarely present in nontuberculous abscesses
MRI: Relatively hypointense on T1-
weighted imaging (T1WI) and relatively hyperintense on T2-weighted imaging (T2WI) show inflammatory tissue esp. abscesses
Large abscess (often bilateral) with thin and smooth wall mainly involve the psoas muscle can spread subligamentously
Well-defined paraspinal region with abnormal signal intensity
Skip lesions Treatment Symptomatic (e.g. analgesic) and
physiotherapyAntituberculosis drugs and surgery
Modic Type 1 Modic Type 1 TuberculousTuberculous SSpondylitispondylitis
Modic type 1 degeneration in a 55-year-old man. (a) Sagittal T1-weighted MR image (450/11) shows decreased signal intensity of the vertebral body bone marrow (arrows) and disk (arrowhead) at the L4-5 level. (b) Sagittal T2-weighted MR image (3066/121) shows increased bone marrow signal intensity and a multilayer pattern (arrows). No fluidlike signal intensity is seen in the disk (arrowhead). (c) Corresponding sagittal contrast-enhanced fat-suppressed T1-weighted MR image (550/11) shows marked bone marrow enhancement (arrows) and an intradiskal vacuum phenomenon (arrowhead).
Tuberculous spondylitis in a 44-year-old woman. (a) Sagittal T2-weighted MR image (3000/120) shows severe diskovertebral destruction, formation of epidural abscesses (arrowhead), and compression of the spinal cord at the T11-12 level. The anterior paraspinal abscess is confined by the anterior longitudinal ligament (arrow) and extends vertically through four levels of the thoracolumbar spine (T10 through L1). (b) Sagittal contrast-enhanced fat-suppressed T1-weighted MR image (446/10) clearly shows a rim-enhancing subligamentous abscess (arrow) that does not encase the intercostal arteries (arrowheads). (c, d) Axial T2-weighted (3000/96) (c) and contrast-enhanced fat-suppressed T1-weighted (979.1/10) (d) MR images show a well-defined paraspinal abscess (arrowhead) with a thin,
smooth wall. The spinal cord is slightly compressed (arrow in d) by the anterior epidural abscess.Reference:Reference:Rahme R and Moussa R. The Modic Vertebral Endplate and Marrow Changes: Pathologic Significance and Relation to Low Back Pain and
Segmental Instability of the Lumbar Spine. Am J Neuroradiol 29:838–42. May 2008Hong SH, et al. MR Imaging Assessment of the Spine: Infection or an Imitation? RadioGraphics 2009; 29:599–612http://emedicine.medscape.com/article/226141 Audrey (2011-061-
115)