Research On Digital Tomosynthesis Combining Various Imaging Assays For The Diagnosis Of Spinal Tuberculosis

Objective:Spinal tuberculosis is a common disease in the whole body bone and joint tuberculosis, more than 50% of which is Spinal tuberculosis. Incidence of spinal tuberculosis gradually increases in recent years. Its diagnosis mainly depends on imaging examination, typical of laboratory examination and clinical examination. If spinal tuberculosis could be diagnosed and treated in early stage, it can effectively avoid occurrence of deformity and paralysis. But the clinical manifestation and imaging data of spinal tuberculosis were inconspicuous in the early stages, which brings certain difficulties to diagnosis and treatment and lead to higher rate of missed diagnosis or misdiagnosis, resulting in serious consequences, such as the occurrence of malformations and paralysis. So if we can accurately diagnose and treat spinal tuberculosis in early stage, it can reduce the incidence of malformations and paralysis. The aim of this study is to evaluate the clinical value of computer tomography(CT), magnetic resonance imaging(MRI), digital radiology(DR) and digital tomosynthesis(DTS) in the diagnosis of spinal tuberculosis, and confirm the results by enzyme-linked cytotoxic assay(ELISPOT) combined with Real time-polymerase Chain Reaction(RT-PCR).Method:Fifty-five cases of spinal tuberculosis patients were included in this study.Patients with spinal tuberculosis were retrospectively analyzed using CT,MRI,DR or DTS. CT was performed with GE16,vertebral body and adjacent vertebral body were scanned. MRI was performed with Philips 3.0T and GE 1.5T, and selected theFov 300.DR was performed with Ysio(Siemens, Germany), and anterior-posterior view and lateral view were adopted. DTS was performed with Sonia vision Satire II(Shimadzu, Japan), using the procedure of TOMOS. The image quality between DR and DTS, and comparing Ratios of detection of bone destruction, sequestration,narrowing or disappearing intervertebral space and parvertebral abscess of DR with DTS were evaluated. The value of digital tomosynthesis(DTS) applied in diagnosing spinal tuberculosis was also studied. At the same time, thirty cases of non-spinal tuberculosis patients included, the examination results of DTS were confirmed by enzyme linked immunosorbent assay combined with fluorescence quantitative RT-PCR(Real time- polymerase Chain Reaction) in diagnosis of spinal tuberculosis.Results:1.?The excellent ratio was 78.18% for CT images, and the ratios of detection of CT of bone destruction, sequestration, narrowing or disappearing intervertebral space, calcification and parvertebral abscess were 78.18%, 63.63%, 27.27%, 90.90%and 65.45%, respectively.?The excellent ratio was 81.81% for MRI images, and the ratios of detection of MRI of bone destruction, sequestration, narrowing or disappearing intervertebral space, calcification and parvertebral abscess were 100.00%, 17.02%, 72.73%,81.82% and 12.73%, respectively.?The excellent ratio was 83.64% for DR images, and the ratios of detection of DR of bone destruction, sequestration, narrowing or disappearing intervertebral space, calcification and parvertebral abscess were 32.73%, 85.45%, 90.91%, 18.18%and 36.36%, respectively.?The excellent ratio was 100.00% for DTS images, and the ratios of detection of DTS of bone destruction, sequestration, narrowing or disappearing intervertebral space, calcification and parvertebral abscess were 69.09%, 100.00%, 90.91%,45.45% and 63.64%, respectively.2.?The results showed that compared with CT, the ratios of detection of DTSof bone destruction and parvertebral abscess was higher, but the ratios of detection of DTS of sequestration, narrowing or disappearing intervertebral space and calcification had no significant difference between CT and DTS.? Compared with MRI, the ratios of detection of DTS of sequestration and calcification was higher, but the ratios of detection of DTS of bone destruction,narrowing or disappearing intervertebral space, and parvertebral abscess had no significant difference between MRI and DTS.? Compared with DR, the ratios of detection of DTS of sequestration,calcification and parvertebral abscess was higher, but the ratios of detection of DTS of bone destruction and narrowing or disappearing intervertebral space had no significant difference between MRI and DTS.3.Enzyme linked immunosorbent assay combined with fluorescence quantitative RT-PCR can use to diagnose spinal tuberculosis.Conclusion:Compared with CT, MRI, and DR, DTS has an advantage in the diagnosis of bone destruction, sequestration, narrowing or disappearing intervertebral space,calcification and par vertebral abscess. Meanwhile, this study confirmed that the enzyme-linked immunospot assay and RT-PCR can be used as an important supplement to DTS in the diagnosis of spinal tuberculosis. This study lays a solid foundation for DTS to guide early diagnosis and treatment of spinal tuberculosis and is of great clinical significance to improve the level in diagnosis of spinal tuberculosis.