Tuberculous spondylitis and pyogenic spondylitis: comparative magnetic resonance imaging features.
METHODS
We retrospectively compared magnetic resonance images (MRIs) of tuberculous (TB) spondylitis and pyogenic spondylitis.


OBJECTIVE
To identify differences between the diseases.


BACKGROUND
Clinical and imaging findings of the 2 diseases are hard to distinguish. MRI may show important differences and aid in early diagnosis and treatment.


METHODS
We compared 22 MRI parameters in 33 patients with TB spondylitis (average age, 66 years) and in 33 patients with pyogenic spondylitis (average age, 65 years).


RESULTS
Seventeen parameters significantly differed between the groups. The most important were local and heterogeneous enhancement of the vertebral body in all patients with TB spondylitis, diffuse and homogeneous enhancement of the vertebral body in 94% of patients with pyogenic spondylitis, vertebral intraosseous abscess with rim enhancement (TB vs. pyogenic, 79% vs. 0%), disc abscess with rim enhancement (9% vs. 64%), and well-defined paraspinal abnormal signal intensity (82% vs. 18%).


CONCLUSIONS
Most parameters occurred in both diseases. Distinctive findings were a pattern of bone destruction with relative disc preservation and heterogeneous enhancement for TB spondylitis and a diskitis pattern (disc destruction) with peridiscal bone destruction and homogeneous enhancement for pyogenic spondylitis. These MRI parameters may facilitate the differential diagnosis of these diseases.
Department of Orthopaedics and Traumatology, Veterans General Hospital-Taipei, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. mcchang@vghtpe.gov.tw
Ming-Chau
MC
Chang
Hung Ta H
HT
Wu
Chi-Han
CH
Lee
Chien-Lin
CL
Liu
Tain-Hsiung
TH
Chen
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology*; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D013166:Spondylitis / Q000453:epidemiology / Q000473:pathology*; D013904:Thoracic Vertebrae / Q000473:pathology*; D014399:Tuberculosis, Spinal / Q000453:epidemiology / Q000473:pathology*