ArticleAJNR. American journal of neuroradiology2014
Diffusion-weighted MRI "claw sign" improves differentiation of infectious from degenerative modic type 1 signal changes of the spine.
Article in AJNR. American journal of neuroradiology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 1 of them a synthesis that pooled it.
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Who cites it
41 citing papers in PubMed, 1 synthesis or guideline pooled it, 111 citations in OpenAlex.
- Measuring and reporting of vertebral endplate bone marrow lesions as seen on MRI (Modic changes): recommendations from the ISSLS Degenerative Spinal Phenotypes Group.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2019Guideline
- Recommendations of the International Consensus Meeting (ICM) 2025 on Spinal Infections: Part A Pyogenic Spondylodiscitis.Global spine journal · 2026Article
- Infectious Spondylodiscitis of Bacterial Causes in Adults: Epidemiology, Pathophysiology, Diagnostic and Treatment Challenges.Microorganisms · 2026Review
- Imaging clues for the diagnosis of various pathogenic causes of infectious spondylitis.Skeletal radiology · 2025Review
- Non-Infectious Spinal Diseases Mimicking Infection: A Pictorial Essay.Journal of the Korean Society of Radiology · 2025Review
- A comprehensive analysis of magnetic resonance imaging and laboratory features in pyogenic, tuberculous, brucellar, and fungal spondylitis.Quantitative imaging in medicine and surgery · 2025Article
- Pyogenic Spondylodiscitis: Predictors of Microbiological Yield from Biopsy in a Tertiary Hospital.Medicina (Kaunas, Lithuania) · 2025Article
- Diagnostic imaging confusion in infectious spondylitis.Journal of orthopaedic surgery and research · 2025Review
- Imaging assessment of spine infection.Skeletal radiology · 2024Review
- Culture-Negative Native Vertebral Osteomyelitis: A Narrative Review of an Underdescribed Condition.Journal of clinical medicine · 2024Review
- Can Hematological Inflammatory Indices Be Used to Differentiate Modic Type 1 Changes from Brucella Spondylodiscitis?Medicina (Kaunas, Lithuania) · 2024Article
- Imaging of Spondylodiscitis: A Comprehensive Updated Review-Multimodality Imaging Findings, Differential Diagnosis, and Specific Microorganisms Detection.Microorganisms · 2024Review
- Differentiation of Native Vertebral Osteomyelitis: A Comprehensive Review of Imaging Techniques and Future Applications.Medical science monitor : international medical journal of experimental and clinical research · 2024Review
- State of the art in the diagnostic evaluation of osteomyelitis: exploring the role of advanced MRI sequences-a narrative review.Quantitative imaging in medicine and surgery · 2024Review
- It is time for a unified definition of native vertebral osteomyelitis: a framework proposal.Journal of bone and joint infection · 2024Review
- Pitfalls of Diffusion-Weighted Imaging: Clinical Utility of T2 Shine-through and T2 Black-out for Musculoskeletal Diseases.Diagnostics (Basel, Switzerland) · 2023Review
- Advances in Bone Marrow Imaging: Strengths and Limitations from a Clinical Perspective.Seminars in musculoskeletal radiology · 2023Article
- Apparent diffusion coefficient values in Modic changes - interobserver reproducibility and relation to Modic type.BMC musculoskeletal disorders · 2022Article
- Should Degenerated Intervertebral Discs of Patients with Modic Type 1 Changes Be Treated with Mesenchymal Stem Cells?International journal of molecular sciences · 2022Review
- Diagnosis of vertebral osteomyelitis.Journal of bone and joint infection · 2022Review
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background and purposeModic type 1 degenerative signal changes can mimic/suggest infection, leading to additional costly and sometimes invasive investigations. This retrospective study analyzes the utility and accuracy of a novel, diffusion-weighted "claw sign" for distinguishing symptomatic type 1 degeneration from vertebral diskitis/osteomyelitis. MATERIALS AND
methodsSeventy-three patients with imaging features resembling type 1 degeneration were classified clinically into 3 groups: true degenerative type 1 changes (n = 33), confirmed diskitis/osteomyelitis (n = 20), and radiologically suspected infection later disproved clinically (n = 20). A claw sign was defined on DWI as well-marginated, linear, regions of high signal situated within the adjacent vertebral bodies at the interface of normal with abnormal marrow. Two blinded neuroradiologists independently rated the presence of the claw sign, along with T2 disk signal and disk and endplate enhancement to determine the utility of each for identifying degeneration versus infection.
resultsWhen the 2 neuroradiologists identified a definite claw, 38 of 39 patients (97%) and 29 of 29 patients (100%) proved to be infection-free. When the readers identified a probable claw, 14 of 14 patients (100%) and 16 of 19 patients (84%) proved to be infection-free. Conversely, when the readers identified the absence of claw sign (diffuse DWI pattern), there was proved infection in 17 of 17 cases (100%) and 13 of 14 cases (93%).
conclusionsIn patients with type 1 signal changes of the vertebral disk space, a claw sign is highly suggestive of degeneration and its absence strongly suggests diskitis/osteomyelitis.
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