Ling-Shan Chen, Zheng-Qiu Zhu, Jing Li, Rui Zhao, Li-Fang Ling, Zhi-Tao Wang, Zhong-Qiu Wang
Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No. 155, Hanzhong Road, Nanjing, 210029, Jiangsu Province, China.
Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China.
Skeletal Radiol. 2024 Apr;53(4):697-707. doi: 10.1007/s00256-023-04459-5. Epub 2023 Oct 16.
To perform a meta-analysis comparing the MRI features of tuberculous and pyogenic spondylitis, using histopathological results and/or blood culture as the standard reference.
PubMed, Embase, Web of Science, and Cochrane Library were searched for English-language studies on the MRI features of tuberculous and pyogenic spondylitis published between January 2010 and February 2023. Risk for bias and concerns regarding applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled MRI features' proportions were calculated using a bivariate random-effects model.
Thirty-two studies met the inclusion criteria: 21 for tuberculous spondylitis, three for pyogenic spondylitis, and eight for both. Of the nine informative MRI features comparing tuberculous spondylitis to pyogenic spondylitis, involvement of ≥ 2 vertebral bodies (92% vs. 88%, P = .004), epidural extension (77% vs. 25%, P < .001), paravertebral collection (91% vs. 84%, P < .001), subligamentous spread (93% vs. 24%, P < .001), thin and regular abscess wall (94% vs. 18%, P < .001), vertebral collapse (68% vs. 24%, P < .001), and kyphosis (39% vs. 3%, P < .01) were more suggestive of tuberculous spondylitis, while disc signal change (82% vs. 95%, P < .001) and disc height loss (22% vs. 59%, P < .001) were more suggestive of pyogenic spondylitis.
Involvement of ≥ 2 vertebral vertebral bodies, soft tissue attribution, thin and regular abscess wall, vertebral collapse, and kyphosis were MRI features more common in tuberculous spondylitis, while disc signal change and height loss were more common in pyogenic spondylitis.
以组织病理学结果和/或血培养作为标准参考，进行一项比较结核性脊柱炎和化脓性脊柱炎MRI特征的荟萃分析。
检索PubMed、Embase、Web of Science和Cochrane图书馆，查找2010年1月至2023年2月发表的关于结核性脊柱炎和化脓性脊柱炎MRI特征的英文研究。使用诊断准确性研究质量评估-2工具评估偏倚风险和适用性问题。使用双变量随机效应模型计算汇总的MRI特征比例。
32项研究符合纳入标准：21项关于结核性脊柱炎，3项关于化脓性脊柱炎，8项两者都有。在比较结核性脊柱炎和化脓性脊柱炎的9项信息性MRI特征中，累及≥2个椎体（92%对88%，P = 0.004）、硬膜外扩展（77%对25%，P < 0.001）、椎旁积液（91%对84%，P < 0.001）、韧带下蔓延（93%对24%，P < 0.001）、脓肿壁薄且规则（94%对18%，P < 0.001）、椎体塌陷（68%对24%，P < 0.001）和后凸畸形（39%对3%，P < 0.01）更提示结核性脊柱炎，而椎间盘信号改变（82%对95%，P < 0.001）和椎间盘高度丢失（22%对59%，P < 0.001）更提示化脓性脊柱炎。
累及≥2个椎体、软组织表现、脓肿壁薄且规则、椎体塌陷和后凸畸形是结核性脊柱炎中更常见的MRI特征，而椎间盘信号改变和高度丢失在化脓性脊柱炎中更常见。
