Role of magnetic resonance imaging features in differentiate between pyogenic spondylitis and tuberculosis spondylitis

Cuong Pham Manh1, Sung-Hoon Park2, Kyu-Sung Kwack2                                                                     

1Radiology department, Bach Mai hospital, Ha Noi, Vietnam

2Radiology department, Ajou university hospital, Suwon, Korea

 

ABSTRACT

Although magnetic resonance imaging (MRI) is the best modality for spondylitis diagnosis but there are some debates in the role of MRI in differentiate between pyogenic spondylitis and tuberculosis spondylitis because of similar in MR imaging concern with early use of antibiotic or early hospitalized.

Objectives

To determine MRI features can help differentiate pyogenic spondylitis (PS) and tuberculosis spondylitis (TS).

Methods

A retrospective study reviewed MR images of 30 spondylitis patients (18 cases of PS and 12 cases of TS). The study included 12 male and 14 female patients with average age of 65 years. One experienced musculoskeletal radiologist reviewed the MRI studies to assess MR features that can help differing PS and TS. Used chi-square test for qualitative variables and t-test for quantitative variables to find out the significant difference between PS and TS groups on MR features.

Results

Among 22 MR features were evaluated, there were 7 features showed significant difference between two groups, included: the vertebral infected section, degree of vertebral collapse, the present of epidural abscess, border of paravertebral inflammation, the present of perivertebral abscess, thickness and contour of perivertebral abscess.

Conclusions

The most distinctive findings for TS were: occurred in thoracic spine, caused severe vertebral body collapse, epidural abscess, paraverterbral abscess with thin and smooth wall. In comparison, the most distinctive findings for PS were: occurred in lumber spine, mild or no vertebral collapse, ill-defined paravertebral soft tissue inflammation, less frequently of paravertebral abscess with  thick and irregular wall.

Keywords

Pyogenic spondylitis, tuberculosis spondylitis, magnetic resonance imaging

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