Vertebral Endplate Signal Abnormality
Jeffrey S. Ross, MD
DIFFERENTIAL DIAGNOSIS
Common
Degenerative Endplate Changes
Schmorl Node
Pyogenic Osteomyelitis
Wedge Compression Fracture
Post-Treatment
Post-Operative Infection
Post-Operative Instability
Post-Operative Degenerative Endplate Changes
Pseudoarthrosis
Post-Traumatic
Neurogenic (Charcot) Arthropathy
Post-Operative
Hemangioma
Less Common
Rheumatoid Arthritis
Ankylosing Spondylitis
Hemodialysis Spondyloarthropathy
Rare but Important
Gout
ESSENTIAL INFORMATION
Helpful Clues for Common Diagnoses
Degenerative Endplate Changes
Type I: ↓ T1, ↑ T2; present in 4% of patients undergoing MR for disc disease
Type II: ↑ T1; present in 16% of patients undergoing MR for disc disease
Type III: ↓ T1, ↓ T2; least common, approximately 1%
Other signs of disc degeneration
No associated soft tissue mass
Schmorl Node
Intravertebral disc herniation
Well-corticated margins
May show ↑ T2 signal if acute
Pyogenic Osteomyelitis
Ill-defined hypointense vertebral marrow on T1WI with loss of endplate definition on both sides of the disc
Paraspinal ± epidural infiltrative soft tissue ± loculated fluid collection
Wedge Compression Fracture
Depression of vertebral endplate, usually superior only
↑ STIR signal intensity, band-like or triangular configuration if acute
Alternative Differential Approaches
Bright T1 signal (fatty endplate) change vs. low T1 signal
Bright T1 signal
Type II degenerative endplate change
Chronic Schmorl node
Chronic compression fracture
Healed osteomyelitis (fatty marrow conversion)
Hemangioma or focal fatty marrow
Low T1 signal
Everything else!
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