PMC2774484_01
(a) Preoperative MRI in Case 1: T2-weighted imaging. Abscess formation with signal hyperintensity is observed between vertebral bodies and epidurally. (b) Preoperative contrast-enhanced CT. Abscess formation (arrow) is visible around the vertebral bodies, with calcification inside. (c) T2-weighted imaging at 18 months postoperatively. Resolution of abscess is indicated. (d) Plain radiography at 30 months postoperatively. Complete bone union has been achieved.
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Regarding magnetic resonance imaging (MRI), T1-weighted imaging showed overall signal hypointensity for both L3 and L4 vertebral bodies, although T2-weighted imaging showed signal hyperintensity presumably indicating abundant abscess accumulation in the disc space, a lesion suspected to be epidural abscess in the spinal canal, and marked compression of the dural sac (Figure 1(a)). Contrast-enhanced computed tomography (CT) showed multiple abscess formation around vertebral bodies with calcification inside (Figure 1(b)). No signal hyperintense regions were apparent in the disc space or epidurally to suggest abscess recurrence on T2-weighted imaging (Figure 1(c)). In addition, plain radiography indicated complete bone union at 30 months postoperatively (Figure 1(d)).
PMC2774484_02
(a) Preoperative gadolinium imaging, axial image. Psoas abscess formation is visible (arrow), along with rim enhancement. (b) T2-weighted imaging at 3 months postoperatively, axial image. The iliopsoas abscess has disappeared. (c) Preoperative CT shows clear cavitations within the L2 vertebral body. (d) CT at 12 months postoperatively indicates that the cavity within the vertebral body has disappeared and has been remodeled.
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Subsequent gadolinium-enhanced imaging showed diffuse contrast in both L2 and L3 vertebral bodies and rim enhancement around the abscess in the right psoas muscle (Figure 2(a)). CT showed a destructive change in the L2 vertebral endplate, and cavitations >=10 mm in diameter were found in vertebral bodies (Figure 2(c)). On T2-weighted imaging, part of the signal hyperintense area remained, but was restricted to the disc space and vertebral bodies, with disappearance of abscess in the right iliopsoas muscle (Figure 2(b)). At 12 months postoperatively, the cavity was completely repaired and disappeared (Figure 2(d)).