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Role of MRI in discrimination of Tubercular ‘vs’ Pyogenic Spondylitis: A comparative study 2012

General Spine

Mohammed Azfar, Siddiqui, M.B.B.S., M.D.
Mohd, Khalid, M.B.B.S., M.D., Non ASSR Member
Ibne, Ahmad, M.B.B.S., M.D., Non ASSR Member
Ekram, Ullah, M.B.B.S., M.D., Non ASSR Member
Mehtab, Ahmad, M.B.B.S., M.D., Non ASSR Member
Saifullah, Khalid, M.B.B.S., Non ASSR Member

Paper/Non-Mentor

Purpose

It is important to differentiate tuberculous spondylitis from pyogenic spondylitis because early treatment have significant influence on the rate of disability and functional impairment. The purpose of this study was to determine the accuracy of MRI for discrimination between tuberculous spondylitis and pyogenic spondylitis.

Methods & Materials

MRI findings in 43 patients with tuberculous spondylitis were retrospectively reviewed and compared with those of 41 patients with pyogenic spondylitis by a single experienced radiologist without knowledge of clinical history or pathology results. The presence or absence of following individual imaging criteria were evaluated and an overall assessment of the type of spondylitis was made- The margin of paraspinal abnormal signal, presence of paraspinal and intraosseous abscess, the appearance of the abscess walls, involvement of multiple vertebral bodies, involvement of posterior element, the extent of subligamentous spread, presence of intervertebral disc narrowing, presence of epidural extension, the signal intensity of involved vertebral bodies, and pattern of contrast enhancement. Statistical analysis was performed with the chi-square test.

Results

The incidence of the following MRI findings was significantly higher in patients with tuberculous spondylitis than in those with pyogenic spondylitis (p < 0.05): a well-defined paraspinal abnormal signal, presence of paraspinal or intraosseous abscess, a thin and smooth abscess wall, subligamentous spread to three or more vertebral levels, involvement of multiple vertebral bodies, and hyperintense signal on T2-weighted images. The involvement of the posterior element, presence of intervertebral disc narrowing, presence of epidural extension and contrast enhancement pattern was not significantly different in tuberculous and pyogenic spondylitis.

Conclusion

MR imaging is a very useful technique for assessment of infectious spondylitis and is reliable for differentiation of tuberculous spondylitis from pyogenic spondylitis.

References/Financial Disclosures

Nothing to disclose

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