The assessment of imaging diagnosis of brucellar spondylitis

Abstract

Objective To explore the imaging features of brucellar spondylitis (BS). Methods The imaging data of 49 cases who were diagnosed as brucellar spondylitis by a positive standard tube agglutination titer test (≥1∶100) and (or) the isolation of brucella species from blood or other tissue at our institution between September 2012 and October 2016 were retrospectively reviewed. X-ray, CT scan and MRI examination was performed in 49, 28 and 42 cases, respectively, of which 19 cases underwent both CT scan and MRI examination. The imaging manifestations of the spine were analyzed. The χ2 test or Fisher's exact test were applied to compare the imaging manifestations of the patients who underwent both CT scan and MRI examination. Results Of the 49 patients, 34 patients (69.4%) had involvement of the lumbar vertebra. Forty-five patients (91.8%) had contiguous involvement at adjacent 2 vertebral bodies. There were 10 cases (20.4%) with bony spur or bone bridge, 3 cases (6.1%) with spondylolisthesis and 3 cases (6.1%) with slightly kyphosis deformity. There were 8 cases (28. 6%) showing bone destruction of more than half of the vertebral body and 6 cases (21.4%) with sequestra on CT. There were 14 cases (33.3%) with psoas abscesses, of which 2 (4.8%) had migrating abscess. Epidural abscesses with dural sac compression were found in 17 cases (40.5%) and 3 cases (7.1%) showed nerve roots compression. There were statistically significant differences in the detection of vertebral bone destruction, bone marrow edema, hyperosteogeny, intervertebral disc changes, abscess formation and sequestrum between CT and MRI (P<0.05). Conclusion BS has characteristic imaging features. The presence of bone destruction, sequestrum, and migrating abscess should warrant the possibility of BS. Key words: Brucellosis; Spondylitis; Tomography, X-ray computed; Magnetic resonance imaging; Diagnosis