Intervertebral Disc, T1 Hypointense

Jeffrey S. Ross, MD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

Kümmell Disease
Pseudoarthrosis
- Neurogenic (Charcot) Arthropathy
- Post-Traumatic Instability
- Post-Operative Spinal Complications

ESSENTIAL INFORMATION

Helpful Clues for Common Diagnoses

Congenital Vertebral Body Fusion
- Linear small low signal disc with “wasp waisting” of vertebral bodies
Degenerative Disc Disease
- Calcification or vacuum phenomenon within intervertebral disc
- Loss of disc space height, vacuum phenomenon seen as low signal within disc on T1WI
- Decreased signal of intervertebral disc on T2WI, loss of central nucleus high signal classic findings of disc degeneration
Osteophyte
- Variable appearance due to type of marrow, degree of cortical bone
- May show linear low signal on all pulse sequences with dense cortical bone
- Larger osteophytes may contain fatty marrow with ↑ T1 signal
- Claw-like appearance contiguous with endplates/disc
Instrumentation/Implants
- Low signal with distortion and spatial mismapping of signal ⇒ high signal surrounding halo
- Small amount of metal artifact may give significant artifact, not visible on CT/plain films
  - Typical following cervical discectomy

Helpful Clues for Less Common Diagnoses

Kümmell Disease
- Nonunited vertebral body fracture undergoes secondary necrosis and collapse
- Nitrogen accumulates in fracture cleft
- Usually elderly, osteoporotic patients
- Low signal on T1WI from gas, variable high signal T2WI, STIR from body
Neurogenic (Charcot) Arthropathy
- Destructive arthropathy when pain and proprioception are diminished/lost, while joint mobility is maintained
- Preserved bone density, bony debris best seen on CT, helps distinguish from infection
- Lumbar spine, rapidly progressive, vacuum phenomenon