Epidural abscess MRI: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
m (Bot: Removing from Primary care)
 
(32 intermediate revisions by 4 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Epidural abscess}}
{{Epidural abscess}}
{{CMG}}; {{AE}} {{JS}}
{{CMG}} {{AE}} {{JS}}; {{AG}}


==Overview==
==Overview==
An epidural abscess is a rare [[suppurative]] [[infection]] of the [[central nervous system]], a collection of [[pus]] localised in the [[epidural space]] lying outside the [[dura mater]], which accounts for less than 2% of focal [[CNS]] infections. <ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref> It may occur in two different places: [[intracranial space|intracranially]] or in the [[spinal canal]].  Because the initial [[symptoms]] and clinical characteristics are not always identical, and are similar to the ones in other diseases, along with the fact that they are both rare conditions, the final [[diagnosis]] might be delayed in time. This late [[diagnosis]] comes at great cost to the patient, since it is usually accompanied by a bad [[prognosis]] and severe [[complications]] with a potential fatal outcome. The [[diagnosis]] of epidural abscess should be first suspected from the clinical findings and posteriorly supported by laboratory tests and imaging studies, however it can only be confirmed after surgical drainage and proper study of the collected material. The laboratory test, despite helpful are not diagnostic and should always be used along history taking, clinical examination and imaging studies. According to the location of the collection, the [[abscess]] may have different origins, different organisms involved, [[symptoms]],  evolutions, [[complications]] and therapeutical techniques. <ref name="DannerHartman1987">{{cite journal|last1=Danner|first1=R. L.|last2=Hartman|first2=B. J.|title=Update of Spinal Epidural Abscess: 35 Cases and Review of the Literature|journal=Clinical Infectious Diseases|volume=9|issue=2|year=1987|pages=265–274|issn=1058-4838|doi=10.1093/clinids/9.2.265}}</ref><ref name="Darouiche2006">{{cite journal|last1=Darouiche|first1=Rabih O.|title=Spinal Epidural Abscess|journal=New England Journal of Medicine|volume=355|issue=19|year=2006|pages=2012–2020|issn=0028-4793|doi=10.1056/NEJMra055111}}</ref>
[[MRI]] may be helpful in the diagnosis of epidural abscess, as it is the preferred imaging study. Epidural abscess appearance varies depending on the location of the disease. On MRI, intracranial epidural abscess appears as a lentiform or crescent-shaped fluid collection. On T2-weighted images, epidural abscesses appear hyperintense compared to the [[cerebrospinal fluid]]. On T1-weighted images, epidural abscesses appear isointense or hypointense when compared to the [[brain]]. Following administration of [[gadolinium]] contrast, the [[dura mater]] is enhanced on T1-weighted images.<ref name=Harris>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref> On [[MRI]], spinal epidural abscess is characterized by low or intermediate intensity on T1-weighted MR sequences and high or intermediate intensity on T2-weighted images.  
 
==MRI==
==MRI==
[[MRI]] is the preferred imaging study in the diagnosis of epidural abscess. MRI is considered to be as effective as [[myelography]] in the diagnosis of epidural abscess, however MRI is superior, particularly in emergency situations, as it allows for visualization of the [[spinal cord]] in all planes without having to move the patient, who might have a neurological injury.<ref name="Grewal2006">{{cite journal|last1=Grewal|first1=S.|title=Epidural abscesses|journal=British Journal of Anaesthesia|volume=96|issue=3|year=2006|pages=292–302|issn=0007-0912|doi=10.1093/bja/ael006}}</ref>
===Intracranial Epidural Abscess===
[[MRI]] is the preferred imaging method to investigate intracranial epidural abscess because it has higher accuracy defining intracranial lesions, compared to [[CT scan]]. On MRI, intracranial epidural abscess is characterized appears as a lentiform or crescent-shaped fluid collection. On T2-weighted images, epidural abscesses appear hyperintense compared to the [[cerebrospinal fluid]]. On T1-weighted images, epidural abscesses appear isointense or hypointense when compared to the [[brain]]. Following administration of gadolinium contrast, the dura mater is enhanced on T1-weighted images.<ref name=Harris>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref>
[[Image:Intracranial epidural abscess.JPG|thumb|left|200px|thumb|Intracranial epidural abscess in the left [[infratentorial]] region<ref name=ICEAMRI> Image courtesy of Dr Bita Abbasi. [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/otomastoiditis-complicated-with-brain-abscess-and-epidural-empyema "here"]). [http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>]]
<br><br><br><br><br><br><br><br><br><br><br><br><br><br><br>


===Spinal Epidural Abscess===
[[MRI]] with [[gadolinium]] [[contrast]] is the preferred method to aid in the [[diagnosis]] of spinal epidural abscess, as it distinguishes the longitudinal and paraspinal extensions of the abscess, allowing for an improved [[neurosurgery|neurosurgical]] approach. On [[MRI]], spinal epidural abscess is characterized by the following:<ref name="pmid7614792">{{cite journal |vauthors=Lang IM, Hughes DG, Jenkins JP, St Clair Forbes W, McKenna F |title=MR imaging appearances of cervical epidural abscess |journal=Clinical Radiology |volume=50 |issue=7 |pages=466–71 |year=1995 |pmid=7614792 |doi= |url=}}</ref><ref name="pmid11996416">{{cite journal |vauthors=Chao D, Nanda A |title=Spinal epidural abscess: a diagnostic challenge |journal=American Family Physician |volume=65 |issue=7 |pages=1341–6 |year=2002 |pmid=11996416 |doi= |url=}}</ref><ref name=SEARadio> Radiopaedia.org (2015) http://radiopaedia.org/articles/spinal-epidural-abscess Accessed on November 20, 2015</ref>
*On T1-weighted MR sequences:
**Low or intermediate intensity
**Fluid portion of an abscess is usually hypointense
**Liquid pus is associated with low signal intensity
**Granulated tissue is enhanced following gadolinium injection


*On T2-weighted images:
**High or intermediate intensity
**Fluid portion of an abscess is usually hyperintense


Additionally, Gd-enhanced MR images can aid in the definition of the age and consistency of the abscess.<ref name="pmid7614792">{{cite journal |vauthors=Lang IM, Hughes DG, Jenkins JP, St Clair Forbes W, McKenna F |title=MR imaging appearances of cervical epidural abscess |journal=Clinical Radiology |volume=50 |issue=7 |pages=466–71 |year=1995 |pmid=7614792 |doi= |url=}}</ref><ref name="pmid11996416">{{cite journal |vauthors=Chao D, Nanda A |title=Spinal epidural abscess: a diagnostic challenge |journal=American Family Physician |volume=65 |issue=7 |pages=1341–6 |year=2002 |pmid=11996416 |doi= |url=}}</ref> It is also helpful in differentiating an abscess from [[malignancy]].<ref name="Grewal2006">{{cite journal|last1=Grewal|first1=S.|title=Epidural abscesses|journal=British Journal of Anaesthesia|volume=96|issue=3|year=2006|pages=292–302|issn=0007-0912|doi=10.1093/bja/ael006}}</ref><ref name="Darouiche2006">{{cite journal|last1=Darouiche|first1=Rabih O.|title=Spinal Epidural Abscess|journal=New England Journal of Medicine|volume=355|issue=19|year=2006|pages=2012–2020|issn=0028-4793|doi=10.1056/NEJMra055111}}</ref> Spinal epidural abscess is frequently associated with evidence of spinal cord compression on MR imaging.<ref name="pmid8079871">{{cite journal |vauthors=Friedmand DP, Hills JR |title=Cervical epidural spinal infection: MR imaging characteristics |journal=AJR. American Journal of Roentgenology |volume=163 |issue=3 |pages=699–704 |year=1994 |pmid=8079871 |doi=10.2214/ajr.163.3.8079871 |url=}}</ref> More information regarding the appearance of spinal epidural abscess can be found [http://eradiology.bidmc.harvard.edu/LearningLab/central/Tukey.pdf here].


[[Image:Spinal epidural abscess(MRI).jpg|thumb|left|200px|thumb|Spinal Epidural Abscess accompanied by C3/C4 level [[discitis]]/[[osteomyelitis]]<ref name=SEAMRI> Image courtesy of Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/epidural-abscess-of-the-cervical-spine "here"]). [http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>]]
<br><br><br><br><br><br><br><br><br><br><br><br><br>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Wikinfect]]
[[Category:Infectious disease]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Primary care]]

Latest revision as of 21:36, 29 July 2020

Epidural abscess Microchapters

Home

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Epidural abscess from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Epidural abscess MRI On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Epidural abscess MRI

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Epidural abscess MRI

CDC on Epidural abscess MRI

Epidural abscess MRI in the news

Blogs on Epidural abscess MRI

Directions to Hospitals Treating Epidural abscess

Risk calculators and risk factors for Epidural abscess MRI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]; Anthony Gallo, B.S. [3]

Overview

MRI may be helpful in the diagnosis of epidural abscess, as it is the preferred imaging study. Epidural abscess appearance varies depending on the location of the disease. On MRI, intracranial epidural abscess appears as a lentiform or crescent-shaped fluid collection. On T2-weighted images, epidural abscesses appear hyperintense compared to the cerebrospinal fluid. On T1-weighted images, epidural abscesses appear isointense or hypointense when compared to the brain. Following administration of gadolinium contrast, the dura mater is enhanced on T1-weighted images.[1] On MRI, spinal epidural abscess is characterized by low or intermediate intensity on T1-weighted MR sequences and high or intermediate intensity on T2-weighted images.

MRI

MRI is the preferred imaging study in the diagnosis of epidural abscess. MRI is considered to be as effective as myelography in the diagnosis of epidural abscess, however MRI is superior, particularly in emergency situations, as it allows for visualization of the spinal cord in all planes without having to move the patient, who might have a neurological injury.[2]

Intracranial Epidural Abscess

MRI is the preferred imaging method to investigate intracranial epidural abscess because it has higher accuracy defining intracranial lesions, compared to CT scan. On MRI, intracranial epidural abscess is characterized appears as a lentiform or crescent-shaped fluid collection. On T2-weighted images, epidural abscesses appear hyperintense compared to the cerebrospinal fluid. On T1-weighted images, epidural abscesses appear isointense or hypointense when compared to the brain. Following administration of gadolinium contrast, the dura mater is enhanced on T1-weighted images.[1]

Intracranial epidural abscess in the left infratentorial region[3]
















Spinal Epidural Abscess

MRI with gadolinium contrast is the preferred method to aid in the diagnosis of spinal epidural abscess, as it distinguishes the longitudinal and paraspinal extensions of the abscess, allowing for an improved neurosurgical approach. On MRI, spinal epidural abscess is characterized by the following:[4][5][6]

  • On T1-weighted MR sequences:
    • Low or intermediate intensity
    • Fluid portion of an abscess is usually hypointense
    • Liquid pus is associated with low signal intensity
    • Granulated tissue is enhanced following gadolinium injection
  • On T2-weighted images:
    • High or intermediate intensity
    • Fluid portion of an abscess is usually hyperintense

Additionally, Gd-enhanced MR images can aid in the definition of the age and consistency of the abscess.[4][5] It is also helpful in differentiating an abscess from malignancy.[2][7] Spinal epidural abscess is frequently associated with evidence of spinal cord compression on MR imaging.[8] More information regarding the appearance of spinal epidural abscess can be found here.

Spinal Epidural Abscess accompanied by C3/C4 level discitis/osteomyelitis[9]














References

  1. ↑ 1.0 1.1 Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
  2. ↑ 2.0 2.1 Grewal, S. (2006). "Epidural abscesses". British Journal of Anaesthesia. 96 (3): 292–302. doi:10.1093/bja/ael006. ISSN 0007-0912.
  3. ↑ Image courtesy of Dr Bita Abbasi. Radiopaedia (original file "here"). Creative Commons BY-SA-NC
  4. ↑ 4.0 4.1 Lang IM, Hughes DG, Jenkins JP, St Clair Forbes W, McKenna F (1995). "MR imaging appearances of cervical epidural abscess". Clinical Radiology. 50 (7): 466–71. PMID 7614792.
  5. ↑ 5.0 5.1 Chao D, Nanda A (2002). "Spinal epidural abscess: a diagnostic challenge". American Family Physician. 65 (7): 1341–6. PMID 11996416.
  6. ↑ Radiopaedia.org (2015) http://radiopaedia.org/articles/spinal-epidural-abscess Accessed on November 20, 2015
  7. ↑ Darouiche, Rabih O. (2006). "Spinal Epidural Abscess". New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 0028-4793.
  8. ↑ Friedmand DP, Hills JR (1994). "Cervical epidural spinal infection: MR imaging characteristics". AJR. American Journal of Roentgenology. 163 (3): 699–704. doi:10.2214/ajr.163.3.8079871. PMID 8079871.
  9. ↑ Image courtesy of Dr Frank Gaillard. Radiopaedia (original file "here"). Creative Commons BY-SA-NC
Retrieved from "https://www.wikidoc.org/index.php?title=Epidural_abscess_MRI&oldid=1637812"