Degenerative (Modic) changes of endplate-bone marrow and their differentiation with spondylodiscitis

Degenerative vertebral endplate and subchondral bone marrow changes were first classified by Modic et al.*
The table below outlines the 3 types of those changes and gives an example of MRI appearance for each of them.

Modic Type 1 changes are hypointense on T1-weighted imaging (T1WI) and hyperintense on T2-weighted imaging (T2WI) and represent bone marrow edema and inflammation. They are associated with disruption and fissuring of endplates and formation of a fibrovascular granulation tissue.		T1- T2+
Modic Type 2 changes are hyperintense on T1WI and isointense or slightly hyperintense on T2WI and associated with conversion of normal red hemopoietic bone marrow into yellow fatty marrow as a result of marrow ischemia.		T1+ T2+
Modic Type 3 changes are hypointense on both T1WI and T2WI and represent subchondral bone sclerosis.		T1- T2-

Mixed-type 1/2 and 2/3 Modic changes have also been reported, suggesting that these changes can convert from one type to another and that they all present different stages of the same pathologic process.

Differentiation between degenerative changes of vertebral endplates and bone marrow and spondylodiscitis can sometimes be problematic. The table below outlines some characteristics of the two pathological processes.

		Degenerative (Modic) changes			Spondylodiscitis
		Type 1	Type 2	Type 3
Endplate/Bone marrow	T1WI	Hypointense	Hyperintense	Hypointense	Hypointense
	T2WI	Hyperintense	Iso- to slightly hyperintense	Hypointense	Hyperintense
	Diffusion	Hypointense (to normal bodies)	Hyperintense	Hypointense	Hyperintense (to normal bodies)
	Contrast Enhanc.	+			+
Intervertebral disc	T1
	T2	Normal or Hypointense			Hyperintense
	Diffusion
Endplate		Normal			Eroded
Paraspinal or epidural inflammation/collection		No			Yes
Lab tests (ESR, CRP)		Normal			High

References
* Modic MT, Steinberg PM, Ross JS, et al. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology1988;166:193–99

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