Tuberculous spondylitis and pyogenic spondylitis: comparative magnetic resonance imaging features

We retrospectively compared magnetic resonance images (MRIs) of tuberculous (TB) spondylitis and pyogenic spondylitis.

To identify differences between the diseases.

Clinical and imaging findings of the 2 diseases are hard to distinguish. MRI may show important differences and aid in early diagnosis and treatment.

We compared 22 MRI parameters in 33 patients with TB spondylitis (average age, 66 years) and in 33 patients with pyogenic spondylitis (average age, 65 years).

Seventeen parameters significantly differed between the groups. The most important were local and heterogeneous enhancement of the vertebral body in all patients with TB spondylitis, diffuse and homogeneous enhancement of the vertebral body in 94% of patients with pyogenic spondylitis, vertebral intraosseous abscess with rim enhancement (TB vs. pyogenic, 79% vs. 0%), disc abscess with rim enhancement (9% vs. 64%), and well-defined paraspinal abnormal signal intensity (82% vs. 18%).

Most parameters occurred in both diseases. Distinctive findings were a pattern of bone destruction with relative disc preservation and heterogeneous enhancement for TB spondylitis and a diskitis pattern (disc destruction) with peridiscal bone destruction and homogeneous enhancement for pyogenic spondylitis. These MRI parameters may facilitate the differential diagnosis of these diseases.