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MRI in differential diagnosis between tuberculous and pyogenic spondylodiscitis
Purpose The aim of the study was to investigate whether MRI findings together with epidemiological data could help in differentiating between tuberculous and pyogenic spondylodiscitis. Methods Clinical records of 260 patients with a suspicion of spondylodiscitis were analysed. Patients were selected...
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| Published in: | European spine journal 2022-02, Vol.31 (2), p.431-441 |
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| container_issue | 2 |
| container_start_page | 431 |
| container_title | European spine journal |
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| creator | Naselli, Nicoletta Facchini, Giancarlo Lima, Giacomo Maria Evangelisti, Gisberto Ponti, Federico Miceli, Marco Spinnato, Paolo |
| description | Purpose
The aim of the study was to investigate whether MRI findings together with epidemiological data could help in differentiating between tuberculous and pyogenic spondylodiscitis.
Methods
Clinical records of 260 patients with a suspicion of spondylodiscitis were analysed. Patients were selected using the following inclusion criteria: confirmed diagnosis of spondylodiscitis either from pyogenic bacteria or from Mycobacterium tuberculosis and contrast-enhanced MRI performed before treatment. Clinical data concerning age, sex and country-of-origin were also collected. For each patient, several MRI-features were evaluated by two-expert musculoskeletal radiologists. A chi-squared test and a multiple logistic regression were used to find the best predictors of tuberculous or pyogenic spondylodiscitis.
Results
114 patients were retrospectively enrolled, 30 with tuberculous and 84 with pyogenic spondylodiscitis. We found 18 MRI-features, significantly different between the two groups. Among these, the most strongly associated with tuberculous spondylodiscitis were: heterogeneous vertebral signal on T1w-sequences (Odds Ratio(OR) = 205.759-
p
|
| doi_str_mv | 10.1007/s00586-021-06952-8 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2560297810</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2560297810</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-563e09a3fb7ae550f37fb2a97164aebfc8eb121d611f339710c76ece288437e63</originalsourceid><addsrcrecordid>eNp9kMtKxDAUhoMoOl5ewIUU3LipniRN0ixFvIEiiK5D2p4MkU46Ji0yb290vIALVyHJd_7z8xFySOGUAqizBCBqWQKjJUgtWFlvkBmtOCtBc7ZJZqArKKWieofspvQCQIUGuU12eMWVZhRm5OH-8bbwoei8cxgxjN72-WLnYUg-FQ2Ob4ihGKcGYzv1w5QKG7piuRrmGHxbpOUQulU_dD61fvRpn2w52yc8-Dr3yPPV5dPFTXn3cH17cX5XtlyJsRSSI2jLXaMsCgGOK9cwqxWVlcXGtTU2lNFOUuo4z8_QKoktsrrO1VHyPXKyzl3G4XXCNJpFboB9bwPmkoYJCUyrmkJGj_-gL8MUQ25nmORM0KqWH4FsTbVxSCmiM8voFzauDAXzodusdZus23zqNnUeOvqKnpoFdj8j334zwNdAyl9hjvF39z-x74fLirg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2632514866</pqid></control><display><type>article</type><title>MRI in differential diagnosis between tuberculous and pyogenic spondylodiscitis</title><source>Springer Link</source><creator>Naselli, Nicoletta ; Facchini, Giancarlo ; Lima, Giacomo Maria ; Evangelisti, Gisberto ; Ponti, Federico ; Miceli, Marco ; Spinnato, Paolo</creator><creatorcontrib>Naselli, Nicoletta ; Facchini, Giancarlo ; Lima, Giacomo Maria ; Evangelisti, Gisberto ; Ponti, Federico ; Miceli, Marco ; Spinnato, Paolo</creatorcontrib><description>Purpose
The aim of the study was to investigate whether MRI findings together with epidemiological data could help in differentiating between tuberculous and pyogenic spondylodiscitis.
Methods
Clinical records of 260 patients with a suspicion of spondylodiscitis were analysed. Patients were selected using the following inclusion criteria: confirmed diagnosis of spondylodiscitis either from pyogenic bacteria or from Mycobacterium tuberculosis and contrast-enhanced MRI performed before treatment. Clinical data concerning age, sex and country-of-origin were also collected. For each patient, several MRI-features were evaluated by two-expert musculoskeletal radiologists. A chi-squared test and a multiple logistic regression were used to find the best predictors of tuberculous or pyogenic spondylodiscitis.
Results
114 patients were retrospectively enrolled, 30 with tuberculous and 84 with pyogenic spondylodiscitis. We found 18 MRI-features, significantly different between the two groups. Among these, the most strongly associated with tuberculous spondylodiscitis were: heterogeneous vertebral signal on T1w-sequences (Odds Ratio(OR) = 205.759-
p
< 0.001), presence of epidural abscess (OR = 86.221-
p
< 0.001), severe vertebral destruction (OR = 10.017-
p
< 0.001) and absence of epidural phlegmon (OR = 86.221-
p
< 0.001). Moreover, patients coming from countries with a middle-high prevalence of tuberculosis were more frequently affected by tuberculous spondylodiscitis than others were (OR = 229.136-
p
< 0.001). The best prediction model demonstrated a correct classification rate of 94.7%.
Conclusion
To the best of our knowledge this is the largest study comparing MRI-features of tuberculous and pyogenic spondylodiscitis. The above-mentioned MRI-features and epidemiological data are crucial in the differential diagnosis between these two entities, guiding the choice of the appropriate therapy, especially when a pathogen cannot be clearly identified with other modalities.</description><identifier>ISSN: 0940-6719</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-021-06952-8</identifier><identifier>PMID: 34379210</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Cellulitis ; Differential diagnosis ; Epidemiology ; Epidural ; Magnetic resonance imaging ; Medicine ; Medicine & Public Health ; Neurosurgery ; Original Article ; Patients ; Prediction models ; Spondylodiscitis ; Surgical Orthopedics ; Tuberculosis ; Vertebrae</subject><ispartof>European spine journal, 2022-02, Vol.31 (2), p.431-441</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-563e09a3fb7ae550f37fb2a97164aebfc8eb121d611f339710c76ece288437e63</citedby><cites>FETCH-LOGICAL-c375t-563e09a3fb7ae550f37fb2a97164aebfc8eb121d611f339710c76ece288437e63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34379210$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Naselli, Nicoletta</creatorcontrib><creatorcontrib>Facchini, Giancarlo</creatorcontrib><creatorcontrib>Lima, Giacomo Maria</creatorcontrib><creatorcontrib>Evangelisti, Gisberto</creatorcontrib><creatorcontrib>Ponti, Federico</creatorcontrib><creatorcontrib>Miceli, Marco</creatorcontrib><creatorcontrib>Spinnato, Paolo</creatorcontrib><title>MRI in differential diagnosis between tuberculous and pyogenic spondylodiscitis</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><addtitle>Eur Spine J</addtitle><description>Purpose
The aim of the study was to investigate whether MRI findings together with epidemiological data could help in differentiating between tuberculous and pyogenic spondylodiscitis.
Methods
Clinical records of 260 patients with a suspicion of spondylodiscitis were analysed. Patients were selected using the following inclusion criteria: confirmed diagnosis of spondylodiscitis either from pyogenic bacteria or from Mycobacterium tuberculosis and contrast-enhanced MRI performed before treatment. Clinical data concerning age, sex and country-of-origin were also collected. For each patient, several MRI-features were evaluated by two-expert musculoskeletal radiologists. A chi-squared test and a multiple logistic regression were used to find the best predictors of tuberculous or pyogenic spondylodiscitis.
Results
114 patients were retrospectively enrolled, 30 with tuberculous and 84 with pyogenic spondylodiscitis. We found 18 MRI-features, significantly different between the two groups. Among these, the most strongly associated with tuberculous spondylodiscitis were: heterogeneous vertebral signal on T1w-sequences (Odds Ratio(OR) = 205.759-
p
< 0.001), presence of epidural abscess (OR = 86.221-
p
< 0.001), severe vertebral destruction (OR = 10.017-
p
< 0.001) and absence of epidural phlegmon (OR = 86.221-
p
< 0.001). Moreover, patients coming from countries with a middle-high prevalence of tuberculosis were more frequently affected by tuberculous spondylodiscitis than others were (OR = 229.136-
p
< 0.001). The best prediction model demonstrated a correct classification rate of 94.7%.
Conclusion
To the best of our knowledge this is the largest study comparing MRI-features of tuberculous and pyogenic spondylodiscitis. The above-mentioned MRI-features and epidemiological data are crucial in the differential diagnosis between these two entities, guiding the choice of the appropriate therapy, especially when a pathogen cannot be clearly identified with other modalities.</description><subject>Cellulitis</subject><subject>Differential diagnosis</subject><subject>Epidemiology</subject><subject>Epidural</subject><subject>Magnetic resonance imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurosurgery</subject><subject>Original Article</subject><subject>Patients</subject><subject>Prediction models</subject><subject>Spondylodiscitis</subject><subject>Surgical Orthopedics</subject><subject>Tuberculosis</subject><subject>Vertebrae</subject><issn>0940-6719</issn><issn>1432-0932</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kMtKxDAUhoMoOl5ewIUU3LipniRN0ixFvIEiiK5D2p4MkU46Ji0yb290vIALVyHJd_7z8xFySOGUAqizBCBqWQKjJUgtWFlvkBmtOCtBc7ZJZqArKKWieofspvQCQIUGuU12eMWVZhRm5OH-8bbwoei8cxgxjN72-WLnYUg-FQ2Ob4ihGKcGYzv1w5QKG7piuRrmGHxbpOUQulU_dD61fvRpn2w52yc8-Dr3yPPV5dPFTXn3cH17cX5XtlyJsRSSI2jLXaMsCgGOK9cwqxWVlcXGtTU2lNFOUuo4z8_QKoktsrrO1VHyPXKyzl3G4XXCNJpFboB9bwPmkoYJCUyrmkJGj_-gL8MUQ25nmORM0KqWH4FsTbVxSCmiM8voFzauDAXzodusdZus23zqNnUeOvqKnpoFdj8j334zwNdAyl9hjvF39z-x74fLirg</recordid><startdate>20220201</startdate><enddate>20220201</enddate><creator>Naselli, Nicoletta</creator><creator>Facchini, Giancarlo</creator><creator>Lima, Giacomo Maria</creator><creator>Evangelisti, Gisberto</creator><creator>Ponti, Federico</creator><creator>Miceli, Marco</creator><creator>Spinnato, Paolo</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20220201</creationdate><title>MRI in differential diagnosis between tuberculous and pyogenic spondylodiscitis</title><author>Naselli, Nicoletta ; Facchini, Giancarlo ; Lima, Giacomo Maria ; Evangelisti, Gisberto ; Ponti, Federico ; Miceli, Marco ; Spinnato, Paolo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-563e09a3fb7ae550f37fb2a97164aebfc8eb121d611f339710c76ece288437e63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Cellulitis</topic><topic>Differential diagnosis</topic><topic>Epidemiology</topic><topic>Epidural</topic><topic>Magnetic resonance imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurosurgery</topic><topic>Original Article</topic><topic>Patients</topic><topic>Prediction models</topic><topic>Spondylodiscitis</topic><topic>Surgical Orthopedics</topic><topic>Tuberculosis</topic><topic>Vertebrae</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Naselli, Nicoletta</creatorcontrib><creatorcontrib>Facchini, Giancarlo</creatorcontrib><creatorcontrib>Lima, Giacomo Maria</creatorcontrib><creatorcontrib>Evangelisti, Gisberto</creatorcontrib><creatorcontrib>Ponti, Federico</creatorcontrib><creatorcontrib>Miceli, Marco</creatorcontrib><creatorcontrib>Spinnato, Paolo</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Naselli, Nicoletta</au><au>Facchini, Giancarlo</au><au>Lima, Giacomo Maria</au><au>Evangelisti, Gisberto</au><au>Ponti, Federico</au><au>Miceli, Marco</au><au>Spinnato, Paolo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>MRI in differential diagnosis between tuberculous and pyogenic spondylodiscitis</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><addtitle>Eur Spine J</addtitle><date>2022-02-01</date><risdate>2022</risdate><volume>31</volume><issue>2</issue><spage>431</spage><epage>441</epage><pages>431-441</pages><issn>0940-6719</issn><eissn>1432-0932</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Purpose
The aim of the study was to investigate whether MRI findings together with epidemiological data could help in differentiating between tuberculous and pyogenic spondylodiscitis.
Methods
Clinical records of 260 patients with a suspicion of spondylodiscitis were analysed. Patients were selected using the following inclusion criteria: confirmed diagnosis of spondylodiscitis either from pyogenic bacteria or from Mycobacterium tuberculosis and contrast-enhanced MRI performed before treatment. Clinical data concerning age, sex and country-of-origin were also collected. For each patient, several MRI-features were evaluated by two-expert musculoskeletal radiologists. A chi-squared test and a multiple logistic regression were used to find the best predictors of tuberculous or pyogenic spondylodiscitis.
Results
114 patients were retrospectively enrolled, 30 with tuberculous and 84 with pyogenic spondylodiscitis. We found 18 MRI-features, significantly different between the two groups. Among these, the most strongly associated with tuberculous spondylodiscitis were: heterogeneous vertebral signal on T1w-sequences (Odds Ratio(OR) = 205.759-
p
< 0.001), presence of epidural abscess (OR = 86.221-
p
< 0.001), severe vertebral destruction (OR = 10.017-
p
< 0.001) and absence of epidural phlegmon (OR = 86.221-
p
< 0.001). Moreover, patients coming from countries with a middle-high prevalence of tuberculosis were more frequently affected by tuberculous spondylodiscitis than others were (OR = 229.136-
p
< 0.001). The best prediction model demonstrated a correct classification rate of 94.7%.
Conclusion
To the best of our knowledge this is the largest study comparing MRI-features of tuberculous and pyogenic spondylodiscitis. The above-mentioned MRI-features and epidemiological data are crucial in the differential diagnosis between these two entities, guiding the choice of the appropriate therapy, especially when a pathogen cannot be clearly identified with other modalities.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>34379210</pmid><doi>10.1007/s00586-021-06952-8</doi><tpages>11</tpages></addata></record> |
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| subjects | Cellulitis Differential diagnosis Epidemiology Epidural Magnetic resonance imaging Medicine Medicine & Public Health Neurosurgery Original Article Patients Prediction models Spondylodiscitis Surgical Orthopedics Tuberculosis Vertebrae |
| title | MRI in differential diagnosis between tuberculous and pyogenic spondylodiscitis |
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