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Vertebral osteomyelitis/diskitis

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History

A patient with a history of back pain and multiple myeloma in remission underwent a routine surveillance PET/CT.


Findings

(@1.1) A:  T1W - Low signal marrow replacement at the L2-L3 level with associated endplate irregularity.  B:  STIR -  bright signal in the same vertebral bodies due to edema.  (@2.1) C:  FDG-PET - Hypermetabolic at the L2-L3 level.  D:  CT from the PET - endplate irregulairities.


Diagnosis

Vertebral osteomyelitis/diskitis


Discussion

FDG-PET/CT has been shown to be useful in identifying infection.  In this case, this was the cause of the patient's back pain and not due to recurrent active multiple myeloma.  The MRI confirmed osteomyelitis/diskitis.  MRI typically shows T1W decreaed signal, T2W or STIR bright signal in the affected vertebral bodies and disc.  Although not shown with this case, a contrast-enhanced MRI would show enhancement in the same areas.


DDx

1. Osteomyelitis/discitis  2.  Degenerative disease  3.  Active myeloma  4.  Tumor


Key points

1.  FDG-PET/CT is useful in identifying infection.   2.  For vertebral osteomyelitis, gallium-67 and MRI are very useful.


References

1. Dagirmanjian A, Schils J, Mchenry M et-al. MR imaging of vertebral osteomyelitis revisited. AJR Am J Roentgenol. 1996;167 (6): 1539-43.   2.  Glaudemans AW, de Vries EF, Galli F et-al. The use of (18)F-FDG-PET/CT for diagnosis and treatment monitoring of inflammatory and infectious diseases. Clin. Dev. Immunol. 2013;2013: 623036.



Vertebral osteomyelitis/diskitis Image 1 with A and B labels.

Image 1 with A and B labels.

Vertebral osteomyelitis/diskitis Image 2 with C and D labels.

Image 2 with C and D labels.

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