Diagnostic accuracy of whole spine magnetic resonance imaging in spinal tuberculosis validated through tissue studies

Kanna, Rishi Mugesh; Babu, Naveen; Kannan, Muhil; Shetty, Ajoy Prasad; Rajasekaran, Shanmuganathan

doi:10.1007/s00586-019-06031-z

Cited by 31 publications

(29 citation statements)

References 14 publications

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“…Jain et al found that 92% of spinal TB patients had subligamentous spread of abscess [24]. In Kanna et al's study, 85% of spinal TB patients had subligamentous spread [25], which is similar with our results (88.67%). Spinal TB mainly spreads via the anterior vertebral arterial; thus, the TB lesions generally began in the anterior superior border of the vertebra.…”

Section: Disease Markerssupporting

confidence: 90%

A Scoring System for Outpatient Orthopedist to Preliminarily Distinguish Spinal Metastasis from Spinal Tuberculosis: A Retrospective Analysis of 141 Patients

She

et al. 2021

Disease Markers

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Objective. Spinal tuberculosis (TB) misdiagnosed of spinal metastasis was not rarely reported, especially in outpatients department. This study was aimed to establish an outpatient scoring system to preliminarily distinguish spinal metastasis from spinal TB. Methods. We retrospectively reviewed consecutive 141 patients with a pathological diagnosis of spinal metastasis (82 cases) or spinal TB (59 cases) in our hospital from January 2017 to June 2018. The following clinical characteristics which can be obtained by outpatient orthopedist were recorded and analyzed: age, gender, malignant tumor history, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and imaging features including distribution characteristics of vertebral lesions, subligamentous spread, paravertebral or psoas abscess, involved vertebral element, intervertebral disc, and sequestra formation. The prevalence of clinical characteristics in spinal metastasis was evaluated, and the scoring system was established using logistic regression analysis. The performance of the scoring system was also prospectively validated. Results. The outpatient scoring system was based on five clinical characteristics confirmed as significant predictors of spinal metastasis, namely, malignant tumor history, subligamentous spread, posterior element lesions, preserved discs, and no sequestra formation. Spinal metastasis showed a significant higher score than spinal TB (8.17 points vs. 1.97 points, t = 18.621 , P < 0.001 ), and the optimal cut-off value for the scoring system was 5 points. The sensitivity and specificity of the scoring system for predicting spinal metastasis were 97.85% and 88.33%, respectively, in the validation set. Conclusion. Spinal lesions with the score of 5 to 10 would be considered a diagnosis of spinal metastasis, while the score of 0 to 4 may be spinal TB. Because the scoring system is mainly based on the clinical characteristics that can be obtained by an outpatient orthopedist, it is suitable to be used as a diagnostic tool in the outpatient department.

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Section: Disease Markerssupporting

confidence: 90%

A Scoring System for Outpatient Orthopedist to Preliminarily Distinguish Spinal Metastasis from Spinal Tuberculosis: A Retrospective Analysis of 141 Patients

She

et al. 2021

Disease Markers

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“…1 ). Similarly, a review done in Pakistan on 60 patients with spinal tuberculosis showed, MRI findings of tuberculosis spine were reduced intervertebral disc space in 95% cases; wedge collapse of body was observed in 30%; complete destruction of vertebral body was seen in 20%; paraspinal abscess and cord compression were observed in 40% and 26.6% respectively [44] ( Table 2 ).…”

Section: Role Of Neuroimaging In Pott’s Disease Particularly In Resource Limited Settingsmentioning

confidence: 86%

Pott’s paraplegia and role of neuroimaging in resource limited setting: A case report and brief review of the literatures

Ayele

Wako

Tadesse

et al. 2021

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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Background Tuberculosis (TB) is the leading cause of morbidity and mortality in low and middle income countries (LMIC). Approximately 50% of cases of skeletal TB involve the spine. Failure to identify and treat these areas of involvement at an early stage may lead to serious complications such as vertebral collapse, spinal compression, and spinal deformity. The clinical and radiologic features of Pott’s disease may mimic other spine diseases such as, metastatic lesions and other infectious etiologies, this is especially imperative in older patients. Case report We report a 60-year-old right handed male patient presented with back pain, paraparesis, and sensory symptoms 2 weeks duration. He has history of dry cough, fatigue, and reduced appetite, but no history of weight loss, fever, night sweat, and bowel/bladder incontinence. No contact history with TB patients. He has a borderline hypertension and diabetes mellitus. Serology for HIV was negative. Thoraco-lumbar magnetic resonance image (MRI) showed destruction of L2 and L3 vertebral body and the inter-vertebral disc; with T2 hyper and T1 hypointensity of the affected vertebral bodies. Probable tuberculous spondylitis with paraparesis was considered and the patient was initiated on antituberculous regimen and short course steroid therapy. After five months treatment, the patient showed significant clinical and radiological improvement. Conclusion In summary, the present case describes, a patient with Pott’s paraplegia due to probable spine tuberculosis and showed significant clinical and radiological improvement following initiation of antituberculous drugs and short course of steroid; indicating the crucial role of imaging in the diagnosis of TB, especially in resource limited settings.

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“…Diagnostic accuracy further improves when combination of above findings are present. 13,20 4) Nuclear medicine studies: Nuclear medicine studies can measure metabolic activity within the lesion, differentiate infectious from non-infectious pathology, identify multifocal disease, and assess response to treatment. 13 Both 99m Tc-Diphosphonate scan and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) can identify abnormal metabolic activity at the site of active inflammation, and multifocal involvement (Fig.…”

Section: ) Magnetic Resonance Imaging (Mri)mentioning

confidence: 99%

Imaging update in spinal tuberculosis

Kubihal¹,

Sharma²,

Kumar³

et al. 2022

Journal of Clinical Orthopaedics and Trauma

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Tuberculosis is ancient disease known to mankind. Diagnosis and management of spinal tuberculosis has immensely improved in last few decades. Imaging, particularly MRI, plays important role in diagnosis of spinal tuberculosis and its complications. Four common imaging patterns of spinal tuberculosis include paradiscal type, central type, Anterior subligamentous type, and posterior type. Imaging also plays important role in differentiation of spinal tuberculosis from its mimics, particularly pyogenic spondylitis, and metastasis. Radiological interventions, such as CT guided vertebral biopsy, and percutaneous drainage of cold abscess, are commonly used in management of spinal tuberculosis. Monitoring of therapeutic response is often based on clinical evaluation and imaging. MRI is most common imaging modality used. Signs of healing include bony ankylosis, resolution of marrow edema, decrease in contrast enhancement, and fatty change with in bone marrow. PET CT is recently evaluated for response assessment with promising results. This review summarizes pathophysiology, clinical presentation, imaging features, radiological interventions, and response assessment in spinal tuberculosis.

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Diagnostic accuracy of whole spine magnetic resonance imaging in spinal tuberculosis validated through tissue studies

Cited by 31 publications

References 14 publications

A Scoring System for Outpatient Orthopedist to Preliminarily Distinguish Spinal Metastasis from Spinal Tuberculosis: A Retrospective Analysis of 141 Patients

A Scoring System for Outpatient Orthopedist to Preliminarily Distinguish Spinal Metastasis from Spinal Tuberculosis: A Retrospective Analysis of 141 Patients

Pott’s paraplegia and role of neuroimaging in resource limited setting: A case report and brief review of the literatures

Imaging update in spinal tuberculosis

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