The Value Of MRI And MR-DWI In Differential Diagnosis Of Brucellar Spondylitis And Tuberculous Spondylitis

Objective To investigate the value of magnetic resonance imaging（MRI）and magnetic resonance diffusion weighted imaging（MR-DWI）in the differential diagnosis of brucellar spondylitis（BS）and tuberculous spondylitis（TS）.Methods From January 2017 to December 2018,We collected 118 samples magnetic resonance images data of patients admitted to the General Hospital of Ningxia Medical University and confirmed to be spinal infection,included 54 cases of BS and 64 cases of TS,which contains 41 samples magnetic resonance diffusion weighted imaging data（21 copies of BS,20 copies of TS）.Our observations are general clinical data,laboratory tests,vertebral bone destruction site,intervertebral disc destruction,intervertebral stenosis,vertebral collapse,paravertebral abscess,epidural abscess,leaping lesions and spinal kyphosis of two groups.According to MRI and MR-DWI features,we chose the region of interest（ROI）and measured the average value of apparent diffusion coefficient（ADC）of pathological area（diseased vertebral body,paravertebral abscess）and the adjacent normal vertebral body of the patients with brucellar spondylitis and tuberculous spondylitis when the diffusion coefficient of sensitivity（b value）is500 s/mm².Results 1.By comparing the MRI features of brucellar spondylitis and tuberculous spondylitis,we found that on the thoracic spine involvement:18.52%（10/54）vs 50.0%（32/64）;2.vertebral collapse:31.48%（17/54）vs 65.63%（42/64）;3.spinal kyphosis:5.56%（3/54）vs 18.75%（12/64）;4.paravertebral abscess:46.29%（25/54）vs 68.75%（44/64）;5.epidural abscess:12.96%（7/54）vs 10.94%（7/64）;6.intervertebral disc destruction:51.85%（28/54）vs 78.13%（50/64）;7.severe intervertebral stenosis:27.78%（15/54）vs 51.56%（33/64）;8 leaping lesions:3.71%（2/54）vs 9.37%（6/64）.The difference were all statistically significant among the thoracic spine involvement,intervertebral disc destruction,intervertebral stenosis,vertebral collapse,paravertebral abscess and spinal kyphosis（P<0.05）,There was no significant difference in the presence of epidural abscess and leaping lesions（P>0.05）..2.When b=500 s/mm²,the average ADC value of BS and TS in the diseased vertebral vertebral body,paravertebral abscess and adjacent normal vertebral body respectively was（1.15±0.10）×10^-3mm² vs（1.29±0.11）×10^-3mm²;（1.71±0.20）×10^-3mm² vs（1.65±0.13）×10^-3mm²/s;（0.46±0.07）×10^-3mm²/s vs（0.47±0.07）×10^-3mm²/s,the ADC values difference between BS and TS in the diseased vertebral body was statistically significant（P<0.05）.The average ADC value of the paravertebral abscess and the adjacent normal vertebral body was not statistically significant（P>0.05）.Conclusion 1.Brucellar spondylitis and tuberculous spondylitis have their own characteristics in the aspects of thoracic spine infection,disc destruction,vertebral stenosis,vertebral collapse,paravertebral abscess and spinal kyphosis,which are helpful for the identification between these two kinds of spinal infection.2.MR-DWI has certain value in the differential diagnosis of brucellar spondylitis and tuberculous spondylitis.By measuring the ADC can quantify the changes in the vertebral body and guide the clinical treatment and follow-up examination in the long term.