Gupta Nitin, Kadavigere Rajagopal, Malla Sundeep, Bhat Shyamasunder N, Saravu Kavitha
Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Infez Med. 2023 Mar 1;31(1):62-69. doi: 10.53854/liim-3101-9. eCollection 2022.
Based on clinical parameters alone, it is difficult to differentiate between tubercular (TB) and pyogenic spondylodiscitis. Therefore, this study aimed to identify imaging features that can help to differentiate these two entities.
This retrospective observational study included microbiologically confirmed cases of TB and pyogenic spondylitis over three years. Magnetic resonance imaging of included cases was reviewed for a predefined set of imaging findings. A multivariable logistic regression analysis was done to compare the radiological features of both groups. A scoring system was created using the features that were significant in univariate and multivariable analysis.
Of the 90 included cases, 44 were TB and 46 were pyogenic. Involvement of the thoracic vertebra, paravertebral abscess, epidural abscess, posterior element involvement, loss of height, spine deformity, nerve compression, destruction of the disc and larger abscess size were more common in patients with TB. Involvement of the thoracic spine, posterior element involvement and spine deformity were independent predictors of diagnosing TB spine. At a score of 7 (out of 11) or above, the scoring system had a sensitivity and specificity of 86% and 94%, respectively, in diagnosing the TB spine.
In the presence of relevant clinical findings, specific MRI findings can help to differentiate TB from pyogenic spondylitis.
仅基于临床参数，很难区分结核性（TB）和化脓性脊椎椎间盘炎。因此，本研究旨在确定有助于区分这两种疾病的影像学特征。
这项回顾性观察研究纳入了三年来经微生物学确诊的TB和化脓性脊柱炎病例。对纳入病例的磁共振成像进行了预定义的一组影像学表现的评估。进行多变量逻辑回归分析以比较两组的放射学特征。使用在单变量和多变量分析中具有显著性的特征创建了一个评分系统。
在纳入的90例病例中，44例为TB，46例为化脓性。胸椎受累、椎旁脓肿、硬膜外脓肿、后部结构受累、椎体高度丢失、脊柱畸形、神经受压、椎间盘破坏和脓肿较大在TB患者中更为常见。胸椎受累、后部结构受累和脊柱畸形是诊断结核性脊柱的独立预测因素。在11分制中，评分达到7分及以上时，该评分系统诊断结核性脊柱的敏感性和特异性分别为86%和94%。
在存在相关临床发现的情况下，特定的MRI表现有助于区分TB和化脓性脊柱炎。
