Intervertebral Disc, T2 Hyperintense

Jeffrey S. Ross, MD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

Pseudoarthrosis
- Neurogenic (Charcot) Arthropathy
- Seronegative Spondyloarthropathy

ESSENTIAL INFORMATION

Helpful Clues for Common Diagnoses

Normal Variant
- Central disc shows biconvex central high signal
- Horizontal low signal extends through nucleus giving bisaucer shape
- Loss of central signal with disc degeneration
Degenerative Disc Disease
- Typical decreased signal of intervertebral disc on T2WI
- May show linear T2 hyperintensity with fluid-filled cleft in disc
- Uncommon discal cysts along posterior margin
- No paravertebral or epidural mass to suggest infection
Vertebral Disc Anular Tear
- Focal increased signal in anulus on T2WI with low signal of parent disc
- T1 C+: Focally enhancing nidus in posterior disc margin
- Discography demonstrates contrast leak from central site of injection through anulus
- Discography is more provocative test (symptom simulation) than diagnostic imaging modality
Post-Operative Change, Normal
- Disc intervention may lead to increased fluid and T2 hyperintensity
- Nonspecific post-operative change
Post-Traumatic
- ↑ T2 signal suggests disc disruption
- Look for disruption of ALL, PLL
Disc Space Infection
- Abnormal disc ↑ T2 with abnormal morphology hallmark of disc space infection
- 2 adjacent vertebrae involved with endplate irregularity and intervening disc abnormality
- Paraspinal ± epidural infiltrative soft tissue ± loculated fluid collection