The Value Of Multimodal MR Imaging In The Diagnosis Of Brucellosis Of Musculoskeletal System

Brucellosis is a common series of clinical manifestations,such as fever,sweating and musculoskeletal pain.The most common have osteoarticular complications after infection.If not treated in time,in most patients,it may lead to nerve function damage or even death in spinal canal.At present,imaging examination,while the research on brucellosis spondylitis is mostly limited to conventional MRI diagnosis,and there is a lack of comprehensive research on the whole involvement of musculoskeletal system and related functional imaging research.The purpose of this study is to comprehensively expound the MRI manifestations of brucellosis of lumbar spine and extraspinal joints,the study of characteristic parameters of DWI and DCE-MRI in the diagnosis of brucellosis,compare and analyze the application value of multi-modality MR imaging technology in the diagnosis of brucellosis of musculoskeletal system with CT and X-ray,and explore brucellosis spondylitis and tuberculous spondylitis.Part ? Clinical application of multimodal MR imaging in the diagnosis of lumbar brucellosisLumbar brucellosis is an infectious spondylitis in China has been on the rise.It is prone to attack the osteoarticular system,and spinal involvement is the common site,especially in the lumbar spine,causing brucellosis spondylitis,which is often clinically characterized by long-term recurrent fever,excessive sweating,and lumbar and back pain as the main manifestation of symptoms.Brucellosis spondylitis is difficult in can significantly reduce the probability of spinal damage and functional impairment.MR imaging of lumbar brucellosis is of great value for its clear quantitative parameter values by combining conventional and enhanced MRI with DWI and DCE-MRI,to make up for the lack of quantitative parameters in conventional MR enhanced imaging,disease.MRI has more characteristic imaging manifestations.Combining epidemiology,and is essential for guiding the clinic treatment,avoiding delaying the disease,and bringing patients timely and effective treatment.ObjectiveTo investigate the clinical application value of conventional MRI scans,DWI and DCE-MRI scans in the diagnosis of lumbar brucellosis.Materials and methodsSeventy-nine patients clinically diagnosed with brucellosis were divided into positive and negative groups according to lumbar vertebrae involvement by MRI.Conventional MRI,DWI and DCE-MRI were performed in both groups,and the diagnostic values of different examination methods for lumbar brucellosis were analyzed.Using workstation software,value at b-values of 0,500 and 800 were extracted in both groups,respectively.The MRI imaging manifestations of the lumbar spine were observed,and the mean ADC value at b=0,b=500,and b=800 in the brucellosis lumbar spine positive and negative groups were statistically analyzed.The relative enhancement,time to peak,wash in rate,and wash out rate of the brucellosis positive and negative groups acquired by image postprocessing were statistically analyzed.3 types of dynamic contrast enhancement-time intensity curve(DCE-TIC):type I,inflow type(incremental);type II,plateau type;and type III,outflow type(washout);and differences in curve types between the brucellosis lumbar spine positive and negative groups were analyzed.Results1.Case grouping:there were 57(72.2%,57/79)cases in the positive group and 22(27.8%,22/79)in the negative group.In patients with positive lumbar brucellosis spondylitis(LBS),33.3%(19/57),50.9%(29/57),10.5%(6/57),3.5%(2/57)and 1.8%(1/57)was involved of 1,2,3,4 and 5 vertebrae,respectively.2.Quantitative parameter ADC value:there were significant differences between the mean ADC values at b=0,b=500,and b=800 between LBS positive and negative patients.3.DCE-TIC characteristics and characteristic parameters:in the lumbar vertebrae positive group with bone destruction(n=57),DCE-TIC of 16 cases showed type I(inflow type),39 showed type II(plateau type),and 2 showed type III(outflow type);in the lumbar vertebrae negative group with no obvious bone destruction(n=22),DCE-TIC of 19 cases showed type I(inflow type)and 3 showed type II(plateau type).The differences in relative enhancement,time to peak,wash in rate and wash out rate were statistically significant in the LBS positive and negative groups.4.Imaging results:in fat suppression-T2WI(FS-T2WI)of the LBS positive group,the lesions showed wormy,lamellar,or irregularly shaped long T1 and long T2 abnormal signals and FS-T2WI hyperintensities;disc involvement showed mixed signals,with narrow intervertebral space;paravertebral soft tissue showed swelling and abscess formation;and intradural epidural involvement appeared in the spinal canal.Vertebral deformation,small joint involvement and sacral involvement were rarely seen;Gd-diethylenetriamine pentaacetic acid(Gd-DTPA)enhancement scan showed lamellar or combined annular enhancement.The negative group showed none of above findings.5.There was no difference in imaging manifestations on MR review after 2-3 months of clinical improvement since the first treatment.ConclusionBy combining conventional MRI,DWI and DCE-MRI,multimodal MR can make up for the lack of quantitative parameters in conventional MR imaging,and comprehensively and accurately elaborate the MRI imaging features of LBS.Combining epidemiology,clinical manifestations and laboratory tests,multimodal MR can improve the accuracy of the diagnosis of LBS.Part ? Clinical application of multimodal MR imaging for the diagnosis of extraspinal osteoarticular brucellosisBrucellosis predisposes to lumbar spondylitis,but extraspinal osteoarticular invasion has been on the rise in recent years.Since extraspinal osteoarticular brucellosis(OB)lacks specific clinical manifestations,and the relevant laboratory tests can only be performed in hospitals specializing in infectious diseases,which all contribute to the reduced detection rate of the disease.However,extraspinal OB is poorly treated with common anti-infection therapy and is somewhat infectious.we observed the characteristic imaging manifestations of MRI of extraspinal OB to continuously.ObjectiveTo investigate the diagnostic value of multimodal MR imaging technology in extraspinal OB,and to improve its diagnostic accuracy.Materials and methodsFifty-eight patients with confirmed diagnosis of extraspinal OB with corresponding joint pain were diagnosed.A 3.0T MRI scanner,large flexure coil,small flexure coil,abdominal coil and knee specific coil were used to perform MR plain scan+DWI+Gd-DTPA enhancement scan of the affected joint.Scan sequences included conventional T1WI and T2WI as well as FS-T2WI,with echo-planar imaging.MRI imaging manifestations of extraspinal OB were observed and analyzed,and the joints involved included sternoclavicular,knee and ankle joints.Results1.In addition to the lumbar spine,the hip joint was most frequently involved in brucellosis,and was also the most susceptible extraspinal joint,followed by the sacroiliac joint.2.Imaging manifestations:the imaging manifestations of extraspinal OB(sternoclavicular,shoulder,sacroiliac,hip,knee,and ankle joints)showed wormy,lamellar,or irregular-shaped bone destruction of the articular constituent bones,with some visible sclerotic edges,feathered as long T1 and long T2 abnormal signals and FS-T2WI hyperintensities.The periarticular soft tissue was swollen and showed long T1 and long T2 abnormal signal and FS-T2WI hyperintensities.In case with abscess formation,the lesion center showed fluid-like distinct long T2 abnormal signals and DWI equal-hyperintensities.The affected joint space was irregularly shaped,narrowed or blurred;some of the synovial membranes were thickened,long T2 fluid signal shadow was seen in the articular cavity,and Gd-DTPA enhancement scan of articular constituent bones and surrounding soft tissues showed obvious inhomogeneous lamellar enhancement.ConclusionMultimodal MR imaging technique can better demonstrate the imaging features of extraspinal OB and the degree and extent of articular soft tissue involvement,and prognostic follow-up of this disease.Part ? The value and comparison of role of multimodal imaging techniques in the diagnosis and differential diagnosis of musculoskeletal system brucellosisBrucellosis has complex,trivial clinical symptoms,from the onset of symptoms to the final appearance of corresponding imaging findings,the incubation period is very long,which may delay the early diagnosis of brucellosis.In turn,relevant studies have shown that incorrect treatment is an important influencing factor in brucellosis recurrence.Therefore,timely and accurate diagnosis and precise lesion assessment are very important.The diagnosis of brucellosis depends on laboratory tests for clarity,in the process of imaging application,it plays a key role in the process of disease diagnosis and later treatment.and follow-up,participating in all aspects of overall disease management.Imaging evaluation by X-ray,CT,and MR can be used for the imaging diagnosis of musculoskeletal system brucellosis,and has important application value in the diagnosis,efficacy monitoring,and recurrence evaluation.we retrospectively analyzed the X-ray,CT and MR imaging data of patients with confirmed brucellosis spondylitis,explored the diagnostic value of X-ray,CT and MR in brucellosis spondylitis,compared the three imaging methods,summarized the advantages and shortcomings of these three examinations for the diagnosis,and studied the differences in MRI characteristics of brucellosis spondylitis and tuberculous spondylitis,In the process of diagnosis of tuberculous spondylitis and brucellosis spondylitis,in order to enhance the efficiency and effect of diagnosis.ObjectiveAnalyze a variety of different detection modes to study the positive effects of X-ray and CT and multimodal magnetic resonance imaging in the process of disease diagnosis,this application incentive effect and value of multimodal magnetic resonance imaging in disease diagnosis and tuberculosis spondylitis.Materials and methodsThe data of 57 cases of brucellosis spondylitis and 35 cases of tuberculous spondylitis confirmed by laboratory tests and surgical pathology from June 2016 to February 2021 were retrospectively analyzed.The multimodal MR,CT and X-ray imaging data of brucellosis spondylitis cases were analyzed.The imaging manifestations of brucellosis spondylitis by the three imaging methods were compared.Multimodal MR imaging was used to compare the distribution and imaging characteristics of the lesioned vertebrae in brucella spondylitis and tuberculous spondylitis.Results1.Involvement of brucellosis spondylitis by MR,CT and X-ray(1)The position of the injured vertebral body was analyzed,and the difference was statistically significant,and the imaging manifestations of vertebral hyperplasia and sclerosis among MR,CT and X-ray;(2)There were statistically significant differences in the imaging manifestations of paravertebral abscess among the three imaging examinations;(3)From the perspective of actual differences in imaging,the differences are statistically significant of intervertebral disc involvement among the three imaging;(4)The position of the injured vertebral body was analyzed,and the difference was statistically significant,and timaging manifestations of vertebral facet joints and epidural involvement within the spinal canal among the three imaging examinations;and(5)There was no statistically significant difference in the imaging manifestations of vertebral body morphology and intervertebral space narrowing among the three imaging examinations.2.MR,CT and X-ray imaging manifestations of brucella spondylitis(1)MR could detect vertebral bone marrow edema,paravertebral microabscess and intervertebral disc involvement in the early stage;(2)CT could detect vertebral microbony destruction in the early stage,and could detect vertebral body deformation,narrowing of the intervertebral space,obvious hyperplasia sclerosis,and lace vertebra like changes in the progressive stage;(3)According to the analysis of X-ray results,it was found that the shape of vertebral body changed,the distance between vertebral bodies decreased,and the bone of vertebral body was damaged,and the hyperostosis of vertebral body margin in the progressive and advanced stages.3.Lesion involvement of brucellosis spondylitis and tuberculous spondylitis by multimodal MR imaging(1)There were statistically significant differences in the distribution of lesioned vertebrae,vertebral hyperplasia and sclerosis,osteoporosis,dead bone or calcification formation and vertebral morphology between brucellosis and tuberculous spondylitis;(2)There were statistically significant differences in the detection rate of paravertebral abscess;(3)The intervertebral disc involvement and intervertebral space stenosis were analyzed,and the difference was statistically significant;(4)There were statistically significant differences in the detection rate of vertebral facet joints involvement;(5)The difference in the detection rate of intraspinal epidural involvement was not statistically significant.4.Differences in imaging manifestations between brucellosis spondylitis and tuberculous spondylitis by multimodal MR imaging techniquesThere were significant differences in the site of bone destruction,paravertebral abscesses,vertebral body morphology,narrowing of intervertebral space,signal changes of intervertebral disc,osteoporosis,pathological dead bone or calcification,vertebral body hyperplasia,vertebral body sclerosis and vertebral facet joint a involvement.Conclusions1.Among the three imaging methods for LBS,X-ray is economical and quick,and can be used as the first choice for brucellosis spondylitis screening method;three-dimensional reconstruction technique of CT has advantages for displaying subtle bone destruction of the vertebral body in brucellosis spondylitis;combining integrated observation of different sequences including T 1WI,T2WI,FS-T2WI and DWI,MR has obvious advantages in the diagnosis of spinal diseases;the comprehensive utilization of X-ray,CT and MR and the complementation of each other's advantages can improve the diagnostic value of brucellosis spondylitis.2.The multimodal MR imaging technique has significant advantages in showing tissue edema and spinal canal involvement,dural sac,and spinal cord.Also,it has high diagnostic value for both brucellosis spondylitis and tuberculous spondylitis and can make effective differential diagnosis.