Tuberculous versus pyogenic spondylodiscitis: MR imaging evaluation

ABSTRACT

Infective spondylitis is a condition that involves one or more of the components of the spinal column. MRI represents a major advance in the examination of the spine because of the direct multiplanar capabilities, increased tissue contrast and improved resolution without the need of iodinated contrast or ionizing radiation. The aim of this study was to evaluate the role of MRI in the diagnosis of Spondylodiscitis and in the differentiation between tuberculous and pyogenic Spondylodiscitis. This study included 23 patients, 10 males and 13 females with age ranging from 19 to 75 years and a mean age of 42.3 years. These patients were subjected to complete clinical and neurological examination, laboratory investigations and MR imaging. T1 WIs and T2 WIs were obtained for all patients and Diffusion study was done in 18 patients. Post contrast [Gd-DTPA] TlWIs in at least two orthogonal planes was also obtained. Patients in this study were divided into pyogenic Spondylodiscitis [16 cases] and tuberculous Spondylodiscitis [7 cases]. MR imaging was an ideal method for evaluating infections of the spine and it is extremely sensitive in detecting and delineating the actual extent of these lesions. Characteristic magnetic resonance findings included destructive lesions involving 2 adjacent vertebrae and the intervening disk, low intensity changes in bone and disc were seen on Tl-weighted images, whereas high intensity changes were seen in those structures on T2-weighted images. Intravenous injection of Gd-DTPA shows enhancement of the involved structures. Paravertebral infection, collections under the posterior longitudinal ligament, and epidural abscesses were also seen in this study. MR imaging is sensitive in diagnosing Spondylodiscitis, demonstrating actual extent of the inflammatory process and in differentiation between pyogenic and tuberculous Spondylodiscitis in most cases