Imaging of Spinal Infection

Foreword
Preface
Contents
Epidemiology of Spinal Infection
	1	 Introduction
	2	 Epidemiology of Spinal Brucellosis
		2.1	 Frequency (Table 1)
		2.2	 Microbiology
		2.3	 Age and Gender
		2.4	 Risk Factors
		2.5	 Location
		2.6	 Clinical Signs
	3	 Epidemiology of Spinal Tuberculosis
		3.1	 Frequency (Table 3)
		3.2	 Microbiology
		3.3	 Age and Gender
		3.4	 Risk Factors (Table 4)
		3.5	 Location
		3.6	 Clinical Signs
		3.7	 Complications
		3.8	 Associated Sites
	4	 Epidemiology of Spinal Pyogenic Infection
		4.1	 Frequency
		4.2	 Microbiology
		4.3	 Age and Gender
		4.4	 Risk Factors
		4.5	 Location
		4.6	 Clinical Signs
	5	 Epidemiology of Spinal Fungal Infection
		5.1	 Candida Spondylodiscitis
		5.2	 Aspergillus Spondylodiscitis
		5.3	 Cryptococcal Spondylodiscitis
		5.4	 Coccidioidal Spondylodiscitis
		5.5	 Blastomycotic Spondylodiscitis
		5.6	 Mycetoma Spondylodiscitis
	6	 Conclusion
	References
Pathophysiology of Spinal Infection
	1	 Introduction
	2	 Routes of Pathogenic Spread
		2.1	 Hematogeneous Route
		2.2	 Non-hematogeneous Route
	3	 Pyogenic Spondylodiscitis
	4	 Tuberculous Spondylodiscitis
	5	 Conclusion
	References
Radiography and Computed Tomography of Spinal Infection
	1	 Introduction
	2	 Overview of Spinal Infection
	3	 Role of Radiographs
		3.1	 Views and Techniques
		3.2	 Radiographic Findings in Spinal Infection
		3.3	 Advantages of Radiographs
		3.4	 Disadvantages and Pitfalls of Radiographs
	4	 Role of CT
		4.1	 CT Acquisition Techniques
		4.2	 CT Findings in Spinal Infection
		4.3	 Dual-Energy CT (DECT)
		4.4	 Role of CT-Guided Biopsy
		4.5	 Advantages of CT
		4.6	 Disadvantages and Pitfalls of CT
	5	 Conclusion
	References
Magnetic Resonance Imaging of Spinal Infection
	1	 Introduction
	2	 Role of MRI in Spinal Infection
		2.1	 MRI of Spine Anatomy
		2.2	 MRI of Spinal Infection
	3	 MRI Technique
		3.1	 Patient Positioning
		3.2	 Coils
		3.3	 Pulse Sequences
			3.3.1	 T1-Weighted Sequence
			3.3.2	 T2-Weighted Sequence
			3.3.3	 Short Tau Inversion Recovery Sequence
			3.3.4	 Fat Suppression Technique
		3.4	 Intravenous Gadolinium-Based Contrast Agent
		3.5	 Diffusion-Weighted Imaging
		3.6	 MRI Protocols and Parameters
	4	 Disadvantages and Pitfalls of MRI
	5	 Conclusion
	References
Nuclear Medicine Imaging of Spinal Infection
	1	 Introduction
	2	 Conventional Nuclear Medicine
		2.1	 Bone Scintigraphy
		2.2	 Gallium-67 (67Ga) Citrate Scintigraphy
		2.3	 Radiolabeled Leukocyte Imaging
		2.4	 Other Types of Radiotracers
			2.4.1	 99mTc Ciprofloxacin (Infection)
			2.4.2	 Streptavidin/111In-Biotin
			2.4.3	 Radiolabeled Antimicrobial Peptides
	3	 Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT)
	4	 Positron Emission Tomography/Computed Tomography (PET/CT)
		4.1	 Fluorine-18-2′-Deoxy-2-Fluoro-d-Glucose ([18F] FDG)
		4.2	 Gallium-68 (68Ga) and Other Radiotracers
	5	 Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI)
	6	 Consensus Guidelines
	7	 Conclusion
	References
Percutaneous Biopsy of Spinal Infection
	1	 Introduction
	2	 General Principles, Indications, and Pre-biopsy Work-Up
	3	 Biopsy Technique
		3.1	 Guidance Methods
		3.2	 Patient Positioning and Biopsy Approach
		3.3	 Biopsy Methods and Needles
		3.4	 Specimen Handling
		3.5	 Follow-Up
	4	 Results
		4.1	 Microbiological Diagnosis of Spinal Infection
		4.2	 Histopathological Diagnosis of Spinal Infection
		4.3	 Cytological Diagnosis of Spinal Infection
		4.4	 Molecular Diagnosis of Spinal Infection
	5	 Complications
	6	 Conclusion
	References
Imaging of Hematogeneous Pyogenic Spondylodiscitis
	1	 Introduction
	2	 Epidemiology
	3	 Pathogenesis
	4	 Clinical Features
	5	 Laboratory Investigations
	6	 Imaging
		6.1	 Radiography
		6.2	 Computed Tomography
		6.3	 Magnetic Resonance Imaging
		6.4	 Nuclear Medicine Imaging
	7	 Treatment
	8	 Conclusion
	References
Imaging of Iatrogenic Spinal Infection
	1	 Introduction
	2	 Epidemiology
	3	 Pathogenesis
		3.1	 Spread
		3.2	 Microorganisms
	4	 Etiology
		4.1	 Preoperative Risk Factors
		4.2	 Intraoperative Risk Factors
	5	 Clinical Presentation
	6	 Imaging
		6.1	 Imaging Techniques
			6.1.1	 Noninstrumented Spine
			6.1.2	 Instrumented Spine
				6.1.2.1 Radiographs
				6.1.2.2 CT
				6.1.2.3 MRI
				6.1.2.4 Nuclear Medicine Imaging
		6.2	 Location
			6.2.1	 Spondylodiscitis
				6.2.1.1 Post-Procedural Spondylodiscitis
				6.2.1.2 Non-Post-Procedural Spondylodiscitis
			6.2.2	 Epidural and Paravertebral Abscess
			6.2.3	 Facet Joint Infection
			6.2.4	 Myelomeningitis
			6.2.5	 Differential Diagnosis
				6.2.5.1 Hematoma
				6.2.5.2 Seroma
				6.2.5.3 Pseudomeningocele
	7	 Management
	8	 Conclusion
	References
Imaging of Pyogenic Epidural Abscess
	1	 Introduction
	2	 Anatomy and Pathogenesis
	3	 Clinical Features
	4	 Laboratory Investigations
	5	 Imaging
		5.1	 Radiography
		5.2	 Computed Tomography
		5.3	 Magnetic Resonance Imaging
	6	 Treatment
	7	 Outcome and Prognosis
	8	 Conclusion
	References
Imaging of Spinal Brucellosis
	1	 Introduction
	2	 Pathophysiology
	3	 Clinical Features
	4	 Imaging Features
	5	 Differential Diagnosis
	6	 Biological Diagnosis
	7	 Histopathological Diagnosis
	8	 Treatment
	9	 Conclusion
	References
Imaging of Salmonella Spondylodiscitis
	1	 Introduction
	2	 Epidemiology
	3	 Pathophysiology
	4	 Sites of Infection
	5	 Clinical Presentation
	6	 Imaging
	7	 Diagnosis
	8	 Treatment and Outcome
	9	 Conclusion
	References
Imaging of Spinal Tuberculosis
	1	 Introduction
	2	 Epidemiology
	3	 Pathophysiology
	4	 Anatomico-Radiological Patterns
		4.1	 Tuberculous Spondylodiscitis (Pott Disease)
			4.1.1	 Pathogenesis
			4.1.2	 Topography
			4.1.3	 Clinical Presentation
			4.1.4	 Imaging Features
				4.1.4.1 Radiographs
				4.1.4.2 Ultrasonography
				4.1.4.3 Magnetic Resonance Imaging (MRI)
				4.1.4.4 Computed Tomography (CT)
				4.1.4.5 Scintigraphic Imaging
			4.1.5	 Topographic Pattern: Cranio-cervical Junction Tuberculosis
			4.1.6	 Differential Diagnosis
			4.1.7	 Imaging Follow-Up
			4.1.8	 Complications
		4.2	 Vertebral Osteomyelitis (Solitary Vertebral Involvement)
		4.3	 Primitive Neural Arch Tuberculosis
	5	 Spinal Tuberculosis Diagnosis
		5.1	 Presumptive Diagnostic Signs
		5.2	 Diagnosis Confirmation
	6	 Treatment
		6.1	 Anti-tuberculosis Treatment
		6.2	 Associated Treatment
	7	 Conclusion
	References
Imaging of Spinal Hydatidosis
	1	 Introduction
	2	 Echinococcus granulosus Life Cycle (Fig. 1)
	3	 Geographic Distribution and Prevalence
	4	 Pathophysiology of Osseous Hydatidosis
	5	 Spinal Hydatidosis
		5.1	 Clinical Features
		5.2	 Imaging
		5.3	 Differential Diagnosis
		5.4	 Diagnosis
		5.5	 Treatment
			5.5.1	 Surgical Treatment
			5.5.2	 Nonsurgical Treatment
	6	 Conclusion
	References
Imaging of Fungal Spondylodiscitis
	1	 Introduction
	2	 Pathogenesis and Clinical Features
	3	 Aspergillosis
	4	 Candidosis
	5	 Cryptococcosis
	6	 Coccidioidomycosis
	7	 Blastomycosis
	8	 Mycetoma
	9	 Conclusion
	References
Diagnostic Algorithm of Spinal Infection
	1	 Introduction
	2	 Diagnosis of Spinal Infection
		2.1	 Clinical Presentation
		2.2	 Laboratory Findings
		2.3	 Imaging
	3	 Image-Guided Percutaneous Biopsy
	4	 Diagnostic Algorithm
		4.1	 Part 1: Clinical Suspicion of Spinal Infection (Fig. 1)
		4.2	 Part 2: Management and Etiological Diagnosis of Spinal Infection (Fig. 2)
		4.3	 Part 3: Patients with Unsuspected Spinal Infection
	5	 Conclusion
	References