Questioning the sensitivity of magnetic resonance imaging in early septic spondylodiscitis

Septic spondylodiscitis is an uncommon disease, but one with serious compli cations and potentially high morbidity and mortality. The diagnosis is some times delayed, particularly in those patients with an insidious mode of ons et and nonspecific symptoms. Several imaging methods are available to facil itate the early diagnosis of septic spondylodiscitis, and of these methods magnetic resonance imaging (MRI) has been reported to be the most sensitive , revealing abnormalities earlier than plain x-ray, gallium scan and bone s can. We report a case of septic spondylodiscitis in which MRI did not demon strate evidence of discitis after a symptom period of seven days. The diagn osis was later confirmed by bone scan and repeat MRI. We suggest that a negative or equivocal MRI cannot exclude infective spondy lodiscitis, especially in the early stages of the disease process. In such cases, it is important to note that the addition of a short tau-inversion r ecovery sequence will increase the sensitivity of MRI, and, additionally, g adolinium should be administered if the magnetic resonance study is negativ e and a strong clinical suspicion of spondylodiscitis exists.