title: Magnetic Resonance Imaging in Differentatial Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis.
abstract: BACKGROUND
  Infectious spondylodiscitis is characterized by the involvement of two adjacent vertebrae and the intervening disc. Incidence rate of the disease is estimated at 0.4-2 cases per 100000 per year.Staphylococcus aureusis the most common infectious agent causing pyogenic spondylodiscitis. Non-pyogenic infections of the spine are most frequently caused byMycobacterium tuberculosis, and fungi. Clinical symptoms are nonspecific. Early diagnosis and appropriate treatment can prevent unfavorable irreversible sequela for the patient. Significant developments in techniques of imaging of pathological tissues raised expectations among the clinicians regarding possibility to distinguish between tuberculous spondylodiscitis and pyogenic spondylodiscitis on MR images. The aim of this study was to identify and differentiate between features of tuberculous and pyogenic spondylodiscitis on MR images.
  
  
  METHODS
  We performed retrospective analysis of MR images obtained from 34 patients with confirmed spondylodiscitis (18 with pyogenic spondylodiscitis, and 16 with tuberculous spondylodiscitis). Data acquisition was performed using 1.5 T MRI scanners where images were obtained using similar protocols. T2 TIRM and T1-weighted images with and without contrast enhancement were subject to assessment in coronal, axial and sagittal planes.
  
  
  RESULTS
  Characteristic features of pyogenic spondylodiscitis include: involvement of the lumbar spine, ill-defined paraspinal abnormal contrast enhancement, diffuse/homogeneous contrast enhancement of vertebral bodies, low-grade destruction of vertebral bodies, hyperintense/homogeneous signal from the vertebral bodies on T2 TIRM images. Prevailing features of tuberculous spondylodiscitis included: involvement of the thoracic spine, involvement of 2 or more adjacent vertebral bodies, severe destruction of the vertebral body, focal/heterogeneous contrast enhancement of vertebral bodies, heterogeneous signal from the vertebral bodies on T2 TIRM images, well-defined paraspinal abnormal contrast enhancement, paraspinal and epidural abscesses, meningeal enhancement at the affected spine level.
  
  
  CONCLUSIONS
  Comparison of MR images of patients diagnosed with pyogenic spondylodiscitis and tuberculous spondylodiscitis allowed identification of individual characteristics for preliminary differentiation between TB and infectious spondylodiscitis and thereby enabling proper treatment.
authors.affiliation: Department of Diagnostic Imaging, Gruca Teaching Hospital, Medical Center of Postgraduate Education, Otwock, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Frel
authors.affiliation: Adults Orthopaedic Ward, II Orthopaedic Department, Gruca Teaching Hospital, Medical Center of Postgraduate Education, Otwock, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Białecki
authors.affiliation: Department of Diagnostic Imaging, Gruca Teaching Hospital, Medical Center of Postgraduate Education, Otwock, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Wieczorek
authors.affiliation: Department of Diagnostic Imaging, Gruca Teaching Hospital, Medical Center of Postgraduate Education, Otwock, Poland.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Paluch
authors.affiliation: Department of Diagnostic Imaging, Gruca Teaching Hospital, Medical Center of Postgraduate Education, Otwock, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Dąbrowska-Thing
authors.affiliation: Department of Diagnostic Imaging, Gruca Teaching Hospital, Medical Center of Postgraduate Education, Otwock, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Walecki
keywords: Bone Diseases, Infectious; Discitis; Magnetic Resonance Imaging; Spine; Tuberculosis, Spinal