Comparison of Magnetic Resonance Imaging Findings between Pathologically Proven Cases of Atypical Tubercular Spine and Tumour Metastasis: A Retrospective Study in 40 Patients

Mittal, Sanjay; Sabir, Aamir Bin; Khalid, Saifullah

doi:10.4184/asj.2016.10.4.734

Cited by 20 publications

(25 citation statements)

References 13 publications

(16 reference statements)

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“…There are numerous similarities in the imaging and clinical manifestations between noncontiguous vertebral TB, a neoplastic disease, lymphoma, and multiple myeloma; however, differentiation requires the presence of a combination of general symptoms, laboratory test results, appropriate radiological results, and the physician's experience. [ 17 , 22 , 23 ] The appearance of vertebral lymphoma at MRI can be nonspecific. However, lesions showing bone marrow replacement and a surrounding soft-tissue mass without large areas of cortical bone destruction suggest lymphoma.…”

Section: Discussionmentioning

confidence: 99%

“…[ 21 ] In neoplastic involvement of the spine, the disc spaces are usually spared, and paravertebral masses are not seen except when solid extraosseous soft tissue component is associated with destructed vertebral bodies. [ 17 , 18 , 22 ] Jung et al [ 24 ] suggested that thin and smooth enhancement of abscess wall and a well defined paraspinal abnormal signal is more in favor of tubercular abscess compared with neoplasm. A study of Khattry et al [ 20 ] reported a case of tuberculous spondylitis in an adolescent was misdiagnosed as a neoplastic disease, due to multiple skip lesions involving vertebral bodies and pedicles with sparing of the intervertebral discs.…”

Section: Discussionmentioning

confidence: 99%

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Skipped multifocal extensive spinal tuberculosis involving the whole spine

Yan

et al. 2018

Medicine

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Rationale:Skipped multifocal extensive spinal tuberculosis (TB) involving the whole spine is very rare. So far, only 3 cases have been reported.Patient concerns:We report a rare case of skipped multifocal extensive TB involving the whole spine of a 33-year-old Chinese male. The patient had been asymptomatic until his symptom was significantly aggravated, which caused him to have difficulty in walking and sleeping. The whole spinal computed tomography (CT) scan showed multifocal worm-eaten and osteolytic bony destruction spread over noncontiguous multilevel vertebral involvement in cervical, thoracic, lumbar, and sacral. In addition, the patient presented with low back pain, progressive fever, night sweats, and weight loss. An open biopsy was undergone indicating granulomatous inflammation after thorough radiographic examinations and laboratory investigations, which to our knowledge have been rarely reported by the published medical reference literature.Dignoses:It was initially diagnosed as lymphoma, multiple myeloma, or a metastatic disease by the radiologist. Final pathology confirmed it as an atypical form of spinal TB, which is extremely rare.Interventions:The patient with no progressive severe neurological symptoms, spinal deformity, or a huge abscess was put on a combination of anti-TB treatment and discharged in an improved state to continue medication for a total of 12 months.Outcomes:This article is a case report, no outcomes.Lessons:Multifocal extensive spinal TB involving the whole spine is rarely reported in the literature, which presents with atypical presentations and imaging features. It is noticeable that the possibility of TB is considered for any skip lesions involving the spine cautiously. Meanwhile, careful physical examination, trials of anti-TB treatment, and using the whole spine MRI routinely also play an important role in the diagnosis and treatment of this disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Skipped multifocal extensive spinal tuberculosis involving the whole spine

Yan

et al. 2018

Medicine

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“…were MRI features for differentiating the cases of spinal TB and MT. 5 In our study, skip lesions and intervertebral space destruction were identified to be the two independent diagnostic factors, and included in the scoring system. For other imaging features, take paraspinal abscess as an example, it is a manifestation highly suggestive of spinal TB, but sometimes TB cases are in the developmental stage in which the abscess has not yet formed (high specificity but low sensitivity).…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 4 Given the similar manifestations, differential diagnosis of the two diseases constitutes a clinical challenge. 3 , 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Scoring System for Differential Diagnosis of Tuberculosis and Metastatic Tumor in the Spine

Cao¹,

Gào²,

Bai³

et al. 2021

IDR

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Purpose Spinal tuberculosis (TB) and metastatic tumor (MT) are common diseases with similar manifestations. Although pathological evaluation is the gold standard to confirm diagnosis, performing biopsies in all patients is not feasible. This study is aimed to create a scoring system to facilitate the differential diagnosis of spinal TB and MT before invasive procedures. Methods Altogether, 447 patients with spinal TB (n=198) and MT (n=249) were retrospectively analyzed. Patients were randomly assigned at 2:1 ratio to a training cohort and a validation cohort. Clinical, laboratory, and radiological diagnostic factors were identified by χ 2 and multiple logistic regression analyses. The scoring system was then established based on the identified independent diagnostic factors scored by regression coefficient β value, with the cut-off value being determined by ROC curve. The sensitivity and specificity of the system was calculated by comparing the predicted diagnosis with their actual pathological diagnosis. Results This scoring system was composed of 5 items: pain worsens at night (0 or 2 points), CRP value (0 or 3 points), tumor marker values (0 or 2 points), skip lesions (0 or 3 points), and intervertebral space destruction (0 or 3 points). Patients scoring higher than 7.5 could be diagnosed as spinal TB, otherwise, MT. According to the internal validation, the sensitivity and specificity of the system were 87.9% and 91.6%, respectively. Conclusion This study established and validated a scoring system which could be used to differentiate spinal TB from MT, thus helping clinicians in quick and accurate differential diagnosis.

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“…1 In our case, atypical imaging features such as spondylitis without discitis, vertebral plana with sclerosis, as well as intraspinal and epidural extra-osseous lesions involving the central and anterior vertebrae were however observed, mimicking lymphoma or tumour metastasis. 2 However, the development of paravertebral abscesses with subligamentous and epidural spread, intra-abscess calcifications, posterior element sparing and absence of skip lesions favoured tuberculosis over malignancy and other infective causes. 2 3 As such, the hepatopulmonary lesions seen on CT were therefore regarded as tuberculomas.…”

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confidence: 99%