Differentiating brucella spondylitis from tuberculous spondylitis by the conventional MRI and MR T2 mapping: a prospective study.

BACKGROUND: Brucella spondylitis (BS) and tuberculous spondylitis (TS), caused initially by bacteremia, are the two leading types of granulomatous spinal infections. BS is easy to miss or may be misdiagnosed as TS. Our purpose aims to differentiate BS from TS in conventional MR imaging and MR T2 mapping. METHODS: We performed on 26 BS and 27 TS patients conventional MR imaging and MR T2 mapping. We analyzed the features in conventional MR imaging and measured T2 values of the lesion vertebrae (LV) and unaffected adjacent vertebrae (UAV) in BS and TS patients, respectively. RESULTS: There were no significant differences in sex, age, national between BS and TS. There was significantly lower severity of vertebral destruction, vertebral posterior convex deformity, dead bone, and abscess scope in BS when compared to TS (p < 0.001, p = 0.048, p < 0.001, p < 0.001, respectively). The vertebral hyperplasia was significantly higher in BS when compared to TS (p < 0.001). The T2 value of the LV with BS was markedly higher than that in the UAV with BS and that in the LV and UAV with TS (p < 0.001, p < 0.037, p < 0.001, respectively). The T2 value of the LV with TS was significantly higher than that of the UAV in TS and BS (p < 0.001, p < 0.001, respectively). There were no significant differences in the T2 value of the UAV between BS and TS (p = 0.568). CONCLUSIONS: The qualitative and quantitative evaluation may differentiate BS from TS. The conventional MR imaging helps to distinguish BS from TS by several distinctive features. MR T2 mapping has the additional potential to provide quantitative information between BS and TS.

The Angiopoietin-like protein 4: a promising biomarker to distinguish brucella spondylitis from tuberculous spondylitis.

OBJECTIVE: The Angiopoietin-like protein 4 (ANGPTL-4) has been proved to be a protein associated with multiple inflammatory responses. Nevertheless, whether it contributes to distinguishing brucella spondylitis (BS) from tuberculous spondylitis (TS) remains an open question. Our study aim is to explore the capability of the ANGPTL-4 to differentiating BS from TS. MATERIALS AND METHOD: In our study, 53 patients were screened out according to the criteria precisely in Xinjiang Medical University Affiliated of the First Hospital from 1 January, 2016, to 31 December, 2018. Their clinical data were retrospectively reviewed. All of them underwent pathological biopsy and magnetic resonance imaging examination. All the frozen tissue sections were stained for testing ANGPTL-4. RESULT: Among the 53 patients, BS had 26 patients, and TS had 27 patients. There was no significant difference between the baseline (P = 0.682) between the two groups. The positive rate of ANGPTL-4 in TS patients (24/27, 88.89%) was higher than that in BS patients (17/26, 65.83%) (P < 0.05). The incidence of microangiopathy and fibrous connective tissue hyperplasia in patients with BS was distinctly higher than those in the TS (P = 0.001, P = 0.008, respectively). Patients of TS frequently presented more granuloma, caseous necrosis, epithelial-like reaction, interleukin 6 (IL-6), and C-reactive protein (CRP) than those of BS. CONCLUSION: Our study provided novel insights into distinguishing BS from TS using the ANGPTL-4 combining with histopathology, which may become new supporting evidence. Key Points • Brucella spondylitis and tuberculous spondylitis are a significant public health concern and even have prolonged damage, contributing to severe health and economic outcomes in Xinjiang of China. • The granuloma, caseous necrosis, epithelioid reaction, microangiosis, and fibrous connective tissue of pathological tissue might play a critical significance for distinguishing brucella spondylitis from tuberculous spondylitis patients. • ANGPLT-4 may become new supporting evidence identify brucella spondylitis and tuberculous spondylitis which is implicated in inflammation angiogenesis-related disorders.

Value of matrix metalloproteinase in differential diagnosis of brucellosis spondylitis and tuberculous spondylitis / 中华地方病学杂志

Objective:To explore the value of matrix metalloproteinase (MMP) in differential diagnosis of brucellosis spondylitis (BS) and tuberculous spondylitis (TS).Methods:Retrospective analysis was used to collect the data of patients with BS and TS diagnosed in the First Affiliated Hospital of Xinjiang Medical University from January 2016 to December 2018. Magnetic resonance imaging (MRI), laboratory data, and the expression levels of MMP-2 and MMP-9 were analyzed.Results:There existed significant differences in imaging findings like the infection levels, the number of infected vertebrae and the paravertebral soft tissue lesions between BS and TS patients ( n=26, 27, P < 0.05). Basophils in BS patients were significantly higher than those in TS patients [(0.022±0.019) × 10 9 number/L vs (0.017±0.007) × 10 9 number/L, t=2.19, P < 0.05]; but the C-reactive protein of BS patients was significantly lower than that of TS patients [(16.12±14.16) mg/L vs (33.78±24.05) mg/L, t=2.45, P < 0.05]. The expression of MMP-9 in BS patients was significantly lower than that in TS patients [76.92% (20/26) vs 96.30% (26/27), χ 2=4.34, P < 0.05], but there was no significant difference in the expression of MMP-2 ( P > 0.05). Conclusion:MMP-9 may be a new biomarker in differential diagnosis of BS and TS, which can be helpful for the differential diagnosis of BS and TS by combining MRI findings with laboratory findings.

Evaluation of the Clinical, Laboratory, and Radiological Findings and Treatment of 19 Cases of Pancreatic Echinococcosis.

BACKGROUND: Hydatid disease is a severe health problem in endemic areas. In recent years, the incidence of this disease in China has been increasing. As the imaging characteristics of pancreatic echinococcosis (PE) are similar to those of cystic diseases, such as cysts, tuberculosis, and tumors, PE is often misdiagnosed and mistreated. METHODS: The clinical manifestations, laboratory tests, radiological findings, and treatment of 19 patients with PE between January 2006 and December 2018 in 2 hospitals were retrospectively analyzed. RESULTS: The mean age of the patients was 38 years, and the ratio of women to men was 2. All patients came from rural areas. Clinical manifestations included cholestatic jaundice, mass, nausea, pain, and swelling. Hemagglutination inhibition test results were positive for all patients. Enzyme-linked immunosorbent assay test results were positive in 17 cases (89.5%). Foci in the pancreas were head in 52.6%, body in 26.3%, body and tail in 15.8%, tail in 5.3%. The size of lesions' diameter ranged from 1 to 12 cm (mean, 6.5 cm). The imaging features of PE included the presence of (a) daughter cysts on abdominal computed tomography (CT) and/or magnetic resonance imaging (MRI); (b) internal cyst wall dissection and ribbon sign on abdominal CT and/or MRI; (c) typical eggshell cyst wall calcification on abdominal CT. CONCLUSIONS: For patients with cystic lesions on CT and/or MRI combined with epidemiological history and positive echinococcosis serology, doctors can correctly diagnose PE earlier. Surgical treatment combined with drugs can reduce the mortality of PE, leading to a better prognosis.

Serum albumin levels and serum albumin-globulin ratio are associated with poor prognosis in glioblastoma.

BACKGROUND: Serum albumin levels (ALB) and albumin-globulin ratio (AGR) are reliable and convenient markers of the nutritional status and inflammation of human body, and ALB has been identified as a prognostic factor in the patients of glioblastoma (GBM). However, no literature has reported the prediction value of AGR for GBM. METHODS: In this study we evaluate the serum ALB and AGR levels for GBM. A total of 126 patients with GBM who underwent surgical resection in our institution between 2013 and 2017 were analyzed retrospectively. Clinical information was obtained from electronic medical records. Multiple logistic regression and Cox proportional hazards models were used to assess the prediction value of preoperative ALB and AGR for GBM. RESULTS: Preoperative ALB (HR 0.342, 95% CI, 0.123-0.954, P=0.040) and postoperative adjuvant therapy (HR 0.042, 95% CI, 0.005-0.330, P=0.003) were significantly related to progression-free survival (PFS). Cox regression analysis showed the significance of adjuvant therapy (HR 3.579, 95% CI, 2.236-5.729, P<0.001). Preoperative AGR (HR 0.280, 95% CI, 0.103-0.763, P=0.013) and adjuvant therapy (HR 0.156, 95% CI, 0.047-0.513, P=0.002) were showed significance, and Cox regression analysis showed preoperative AGR (HR 1.810, 95% CI, 1.095-2.992, P=0.021) and adjuvant therapy (HR 4.702, 95% CI, 2.841-7.782, P<0.001) were independent predictors of overall survival (OS). CONCLUSIONS: The ALB and AGR had significant predictive values for the prognosis of GBM; postoperative adjuvant treatment is also an independent predictor for the prognosis of GBM patients.

Quantitative evaluation of magnetic resonance T2 mapping in Brucella spondylitis / 中华地方病学杂志

Objective:To analyze the characteristics and quantitative evaluation of Brucella spondylitis patients by magnetic resonance T2 mapping. Methods:A prospective clinical study was conducted to analyze the MRI data of 23 patients with brucellosis spondylitis diagnosed in the First Affiliated Hospital of Xinjiang Medical University from January 2016 to September 2018, and 25 healthy volunteers were selected as the control group. MRI was used to examine the vertebral bodies of the subjects, and T2 mapping map was automatically generated. Regions of interest (ROI) were selected on the T2 mapping map to generate T2 mapping values automatically. The T2 mapping values of diseased vertebrae, adjacent unaffected vertebrae, paravertebral abscess and healthy volunteers were analyzed.Results:Among 48 MRI examinees, 23 cases were Brucella spondylitis, including 17 males and 6 females, aged (38.5 ± 13.4) years; 25 healthy volunteers, including 15 males and 10 females, aged (35.1 ± 12.7) years. In 23 patients with Brucella spondylitis, 5 thoracic vertebrae, 40 lumbar vertebrae and 7 sacral vertebrae were involved, with a total of 52 vertebral bodies. Among them, 11 (21.2%) vertebral bodies showed bone marrow edema on MRI, 41 (78.8%) vertebral bodies showed bone marrow edema and vertebral bone destruction. T2 mapping values of the diseased vertebrae, adjacent unaffected vertebrae and paravertebral abscess in Brucella spondylitis patients and normal vertebrae in healthy volunteers were (115.62 ± 11.37), (75.21 ± 5.57), (240.26 ± 30.67) and (77.29 ± 4.19) ms, respectively. There were significant differences between the diseased vertebrae in Brucella spondylitis and adjacent unaffected vertebrae in Brucella spondylitis, and there were significant differences between the diseased vertebrae in Brucella spondylitis and normal vertebrae in healthy volunteers ( t = 26.78, 19.42, P < 0.05). Conclusion:Magnetic resonance T2 mapping can be used to evaluate the pathological tissues in Brucella spondylitis patients, and it has certain guiding significance for the quantitative description and qualitative diagnosis.

The value of MRI in differentiating Brucella spondylitis from tuberculosis spondylitis / 中华地方病学杂志

Objective:To evaluate the value of magnetic resonance imaging (MRI) in differentiating Brucella spondylitis from tuberculosis spondylitis. Methods:A retrospective analysis method was used to include Brucella spondylitis patients and tuberculous spondylitis patients who had undergone MRI examination at the First Affiliated Hospital of Xinjiang Medical University from January 2015 to December 2017. All patients data of MRI examination (all had T1WI, T2WI, STIR images) were collected and compared. The differences in lesion location, MRI signal, vertebral body destruction, vertebral wedge, kyphosis deformity, attachment destruction, dead bone, bone hyperplasia, intervertebral space change, abscess location, and abscess range were analyzed. Results:A total of 91 patients with brucella spondylitis were selected, including 36 women and 55 men, with an average age of 49.40 years old; 112 patients with tuberculous spondylitis selected in the same examination, including 48 women and 64 men, with an average age of 47.15 years old. There was no statistically significant difference in gender and age between the two groups (χ 2 = 0.225, t = 1.387, P > 0.05). Brucella spondylitis was more common in lumbar spine [72.53% (66/91)], and tuberculosis spondylitis was more common in thoracic spine [47.32% (53/112)]. Brucella spondylitis patients showed higher T2WI hyperintensity than tuberculosis spondylitis patients [51.65% (47/91) vs 24.11% (27/112), P <0.05]; and showed lower T2 hyperlipidemia than patients with tuberculosis spondylitis [59.34% (54/91) vs 72.32% (81/112), P < 0.05]; the incidence rates of mild destruction of vertebral body, bone hyperplasia, normal intervertebral space, paravertebral abscess, and abscess not exceeding the range of vertebral body were higher than those of patients with tuberculosis spondylitis [81.32% (74/91), 93.41% (85/91), 37.36% (34/91), 71.43% (65/91), 38.46% (35/91) vs 20.54% (23/112), 28.57% (32/112), 1.79% (2/112), 30.36% (34/112), 1.79% (2/112), P < 0.01]; the incidence rates of vertebral body severe destruction, vertebral wedge less than 1/2, kyphosis deformity, dead bone, inter vertebral space narrowing, inter vertebral space vanishing, psoas abscess, abscess beyond the range of vertebral body were lower than those of patients with tuberculous spondylitis [12.09% (11/91), 18.68% (17/91), 2.20% (2/91), 2.20% (2/91), 61.54% (56/91), 1.10% (1/91), 2.20% (2/91), 1.10% (1/91) vs 75.89% (85/112), 72.32% (81/112), 29.46% (33/112), 46.43% (52/112), 79.46% (89/112), 18.75% (21/112), 66.96% (75/112), 74.11% (83/112), P < 0.01]. Conclusions:MRI signs can be used to differentiate Brucella spondylitis from tuberculosis spondylitis through analysis of bone hyperplasia, vertebral body destruction, vertebral wedge, kyphosis deformity, dead bone, abnormal intervertebral space, and paravertebral abscess and psoas abscess.