Usually, MR imaging of the spine is performed with basic sequences including T1 and T2 weighted sagittal and axial images. Additionally, fat-suppressed T2-weighted sequence or Short tau Inversion Recovery (STIR) sequence is used to increase the conspicuity of bone marrow edema and thus increasing the sensitivity [
6]. If there is no bone marrow edema on fat suppressed T2-weighted or STIR images, gadolinium contrast administration does not add any value and is not required [
25]. However, in many institutions, intravenous gadolinium contrast is usually administered in all suspected cases of vertebral infection. Its main role lies in differentiating phlegmon from epidural abscesses (this latter demonstrates peripheral enhancement with central non-enhancing component), which is very important in deciding the appropriate treatment as epidural abscesses require surgical treatment in many cases, while phlegmon is usually treated with medical treatment [
26]. In patients who cannot undergo contrast-enhanced MRI due to contraindications such as poor renal function or allergic reactions, usefulness of diffusion weighted imaging (DWI) for detection of abscesses has been demonstrated in the literature [
21,
27,
28]. Some authors advocate its routine use in clinical practice because DWI may help differentiate between abscess and other pathologies such as non-infected cystic lesions (postoperative seroma, hematoma), cerebrospinal fluid leak, cystic/necrotic tumor and unusual patterns of degenerative disc and facet joint changes [
21]. For assessment of spinal and paraspinal abscesses, DWI is performed with b values of 50 and 1000 s mm
−2 and the apparent diffusion coefficient (ADC) map [
21]. Image distortion can be reduced by deploying the parallel imaging factor 2. A spin-echo-type echo planar DWI sequence which allows fast imaging is commonly used to reduce motion artifacts [
21].