Chulalongkorn Medical Journal


P O’Charoen


Background : Although magnetic resonance imaging (MRI) has been the most sensitiveand useful investigation in detecting and delineating spinal lesion, spinaltumor and spinal infection may be difficult to be distinguished.Objective : To find reliable findings to differentiate spinal tumor from spinal infection.Methods : Four hundred and seventy-nine cases of spinal MRI in 12 months wereretrospectively reviewed. Sixty - one cases with MRI diagnosis of spinaltumor or spinal infection were included in the study. Sex, age, location,number of the level of spinal involvement and paravertebral/epiduralextension were documented. White blood cell count and percentage ofneutrophils were reviewed, if available. Vertebral marrow, disc, paravertebralsoft tissue and spinal cord signal intensity (SI) on T1 - and T2 - weightedimages, and post gadolinium enhancement were graded.Results : There were 28 cases of spinal tumor and 24 cases of spinal infection.The significant MRI findings (p - value less than 0.05) between two groupsare disc signal on T1 - and T2 - weighted images, disc enhancement,paravertebral soft tissue signal on T1 - weighted images and paravertebralsoft tissue enhancement. Paravertebral/epidural abscesses are found onlyin the spinal infection group. Sacral location is seen only in the spinaltumor group. Age of more than 50 years, multiple levels of involvementand thoracic location are shown in the spinal tumor group more than theinfection group.Conclusion : Decreased disc SI on T1 - weighted images, increased disc SI onT2 - weighted images, disc enhancement, decreased paravertebral softtissue SI on T1 - weighted images, paravertebral soft tissue enhancementand paravertebral/epidural abscesses are significant findings in spinalinfection which is useful in differentiation from spinal tumor. Sacral locationis therefore considered spinal tumor. Age of more than 50 years, multiplelevels of involvement and thoracic location increase possibility of spinaltumor.


Faculty of Medicine, Chulalongkorn University

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