CT and MRI features and differential diagnosis of pyogenic spondylitis and thoracolumbar tuberculosis
Objective To explore the CT and MRI features and diagnostic value in the differential diagnosis of pyogenic spondylitis and thoracolumbar tuberculosis.Methods Clinical and imaging data of 41 patients with pyogenic spondylitis and 44 patients with thoracolumbar tuberculosis admitted to the Mianyang Orthopedic Hospital from June 2019 to June 2022 were collected.The charac-teristics of calcification,density,location of bone destruction,and type of lesions in the two diseases were analyzed.The diagnostic value of MRI and CT in the differential diagnosis of the diseases was explored using pathological results as the gold standard.Results Overall,33 cases of pyogenic spondylitis and 37 cases of thoracolumbar tuberculosis were found in the differential diagnosis using CT,with a moderate consistency with pathological results(Kappa value=0.646,P<0.05).A total of 39 cases of pyogenic spon-dylitis and 41 cases of thoracolumbar tuberculosis were found in the differential diagnosis using MRI,with a higher consistency with pathological results(Kappa value = 0.882,P<0.05).The sensitivity and accuracy of MRI in the differential diagnosis of pyo-genic spondylitis and thoracolumbar tuberculosis were 95.12%and 94.12%,respectively,significantly higher than the 80.49%and 83.35%of CT examination(P<0.05).No statistically significant difference was observed in the specificity of the two examination methods(P>0.05).CT examination results showed that patients with pyogenic spondylitis had vertebral body height involvement of no less than 1/2 of the normal vertebral body,calcium-like high density in the area of bone destruction,involvement of 5 append-ages or more,and lower proportion of abnormal soft tissue calcification around the vertebrae compared to patients with thoracolum-bar tuberculosis.The proportion of vertebral body worm-eaten type bone destruction and sclerosis around the lesion was significantly higher than that of patients with thoracolumbar tuberculosis(P<0.05).MRI examination results showed that the site of bone de-struction in patients with pyogenic spondylitis was marginal,the type of bone destruction was granuloma,there was no interverte-bral disc narrowing,localized abscess around the vertebrae,localized intervertebral disc destruction,no necrosis or calcification,and no vertebral collapse or angular deformity,all of which were significantly higher than those in patients with thoracolumbar tubercu-losis(P<0.05).No statistically significant difference was noted in the segmental involvement of the two diseases(P>0.05).Conclusion Both MRI and CT examinations can effectively differentiate between thoracolumbar tuberculosis and pyogenic spondyli-tis,but MRI has a higher diagnostic efficacy.Combined with the imaging signs and clinical features of patients,this technique can provide further assistance in preoperative diagnosis.