19 Nonneoplastic Lesions of Vertebral Bodies on Magnetic

Resonance Imaging

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig SP 19-1 Degenerative disk disease (type I changes). (A) Sagittal T1-weighted image shows a broad area of decreased signal intensity adjacent to the L3-4 disk. (B) Gradient echo image shows mildly increased signal intensity (arrows) in the corresponding area.11

• Fig SP 19-2 Degenerative disk disease (type II changes). (A) Sagittal T1-weighted image shows a sharply marginated area of increased signal intensity (arrows) adjacent to a narrowed disk space. (B) On the T2-weighted image, this area has a slightly increased signal intensity.14

• Fig SP 19-3 Degenerative disk disease (type III changes). (A) Sagittal T1-weighted image shows ill-defined zones of decreased signal intensity within the end plates adjacent to the L3-4 intervertebral disk (thick arrows). (Thin arrows indicate lumbar interspaces.) (B) On the T2-weighted image, these end plates become isointense with normal marrow (arrows).12

• Fig SP 19-4 Schmorl's nodes. Central herniation of disk material through the superior end plates of T12 and L3 (arrows).12

• Fig SP 19-5 Compression fractures (subacute and chronic). Sagittal (A) T1-weighted and (B) T2-weighted images show anterior compression deformities (wedging) of the T7 and T11 vertebral bodies (large arrows). The signal intensity of the marrow is normal at T11, indicating a healed chronic compression fracture. At T7, the signal intensity of the marrow is decreased on the T1-weighted image and slightly increased on the T2-weighted image in a linear, heterogeneous fashion (small arrows, B), consistent with a subacute compression fracture.14

• Fig SP 19-6 Infection. (A) Sagittal T1-weighted image shows a large area of decreased signal intensity involving both sides of the L4-5 disk space. The boundaries between the disks and the end plates are obliterated (arrows). (B) T2-weighted image shows sharply marginated areas of increased signal intensity (arrows) adjacent to the disk, which shows mottled, irregular signal characteristics.14

• Fig SP 19-7 Radiation therapy. Axial T1-weighted image in a patient after radiation therapy for a plasmacytoma of L4 shows the typically increased signal intensity from L2, L3, L4, and the inferior aspect of L1, consistent with fatty replacement of bone marrow in a distribution corresponding to the radiation therapy port.14

• Fig SP 19-8 Paget's disease. (A) Lateral radiograph showing involvement of L3 (curved arrow) and L2 (straight arrow). (B) Midsagittal T1-weighted MR image shows mottled signal intensity in L3 (curved arrow) and T2 (straight arrow). The affected vertebrae appear slightly enlarged.11