The use of IV contrast not only increases lesion conspicuity, characterized by foci of abnormal soft tissue enhancement and peripherally enhancing fluid collections within and/or surrounding the affected spinal segment, but also helps to define the extent of the infectious process [3]. MRI is also used to help distinguish expected postoperative changes at the surgical skin site from infection and contrast-enhanced MRI can be used to assess postoperative fluid collections for suspected infection [28,29,69,70]. MRI when performed without IV contrast may have utility, because it can show findings that are suggestive of possible spine infection, including marrow or paraspinal muscle edema, abnormal fluid collections, areas of abnormal signal, abnormality within the intervertebral disc, and adjacent vertebral endplates and gross structural abnormalities of the involved spine segment(s) [3,10,14,16,17,30,63-66,69]. MRI performed with IV contrast only is not considered to be useful because the precontrast MRI study is required for comparison in order to confirm areas of suspected abnormality within the spine segment(s) of interest. The presence and extent or the absence of contrast enhancement are important imaging features in suspected spinal infection and are best evaluated by comparing the pre- and postcontrast MRI examinations. Radiography Spine Area of Interest Radiography provides a quick survey of the soft tissues and underlying osseous structures at the site of suspected spine infection when either a decubitus ulcer or wound is present [3]. Radiography can be used to tailor a subsequent cross-sectional imaging examination especially in patients with prior spine surgery or interventions [8]. 3-Phase Bone Scan A 3-phase bone scan with Tc-99m-MDP has variable moderate-to-high sensitivity (81.4%) and low specificity (40.7%) for suspected spine infection with decubitus ulcer or wound overlying the spine [31].
Suspected Spine Infection PCAs. The use of IV contrast not only increases lesion conspicuity, characterized by foci of abnormal soft tissue enhancement and peripherally enhancing fluid collections within and/or surrounding the affected spinal segment, but also helps to define the extent of the infectious process [3]. MRI is also used to help distinguish expected postoperative changes at the surgical skin site from infection and contrast-enhanced MRI can be used to assess postoperative fluid collections for suspected infection [28,29,69,70]. MRI when performed without IV contrast may have utility, because it can show findings that are suggestive of possible spine infection, including marrow or paraspinal muscle edema, abnormal fluid collections, areas of abnormal signal, abnormality within the intervertebral disc, and adjacent vertebral endplates and gross structural abnormalities of the involved spine segment(s) [3,10,14,16,17,30,63-66,69]. MRI performed with IV contrast only is not considered to be useful because the precontrast MRI study is required for comparison in order to confirm areas of suspected abnormality within the spine segment(s) of interest. The presence and extent or the absence of contrast enhancement are important imaging features in suspected spinal infection and are best evaluated by comparing the pre- and postcontrast MRI examinations. Radiography Spine Area of Interest Radiography provides a quick survey of the soft tissues and underlying osseous structures at the site of suspected spine infection when either a decubitus ulcer or wound is present [3]. Radiography can be used to tailor a subsequent cross-sectional imaging examination especially in patients with prior spine surgery or interventions [8]. 3-Phase Bone Scan A 3-phase bone scan with Tc-99m-MDP has variable moderate-to-high sensitivity (81.4%) and low specificity (40.7%) for suspected spine infection with decubitus ulcer or wound overlying the spine [31].