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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Epidural abscess MRI

Introduction

Overview

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

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

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

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]