Tuberculous Spondylitis and Pyogenic Spondylitis: Comparative Magnetic Resonance Imaging Features

Ming-Chau Chang, MD; Hung Ta H. Wu, MD; Chi-Han Lee, MD; Chien-Lin Liu, MD; Tain-Hsiung Chen, MD


Spine. 2006;31(7):782-788. 

In This Article


As shown in Table 1 , the only significant difference in the basic clinical data were a longer average duration of symptoms and signs in the TB group compared with in the pyogenic group (7 vs. 3.2 months). The thoracic spine was more often involved in the TB group, and the lumbar spine was more often involved in the pyogenic group. In both groups, the disease involved 2 vertebrae in most patients, but TB spondylitis was more than twice as likely as pyogenic spondylitis to involve 3 vertebrae. In 1 patient, 4 vertebrae were involved.

Table 2 , Table 3 , and Table 4 show the changes in signal intensity, the degree of disc and bone destruction, and contrast enhancement and CT findings. Of the 22 parameters studied, the following 17 were significantly different between the groups: 1) signal intensity on T2-weighted MRI, 2) disc preservation (TB group vs. pyogenic group, 61% vs. 6%), 3) grade of bone destruction, 4) loss of cortical definition (100% vs. 27%), 5) disc abscess with peridiscal rim enhancement (9% vs. 64%), 6) enhancement of the vertebral body (focal and heterogeneous in all TB cases, diffuse and homogeneous in 94% of pyogenic cases), 7) vertebral intraosseous abscess with rim enhancement (79% vs. 0%), 8) paraspinal abscess with rim enhancement (82% vs. 30%), 9) loculated abscess (61% vs. 18%), 10) epidural extension (91% vs. 61%), 11) epidural abscess with rim enhancement (45% vs. 18%), 12) paraspinal area of abnormal signal intensity (well defined, 82% vs. 18%; ill defined, 18% vs. 82%), 13) anterior longitudinal ligament spread (73% vs. 39%), 14) kyphotic angle on MRI and 15) plain radiographs, 16) paraspinal calcification (65% vs. 17%), and 17) pedicle destruction (75% vs. 8%).

Differences in signal intensity on T1-weighted MRI, patterns of disc enhancement, pedicle enhancement, size of paraspinal abscesses, and vertebral fragmentation were not significant.

Twenty patients in the TB group and 15 in the pyogenic group had kyphotic deformity at the site of the lesion. The average kyphotic angle was significantly greater in the TB group than in the pyogenic group, as shown on MRIs and plain radiographs. The average radiographic angle was 3º greater than the MRI angle, but the difference was not significant.


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