The challenges in differentiating tuberculous from pyogenic spondylitis using magnetic resonance imaging

Abstract

The challenges in differentiating tuberculous from pyogenic spondylitis using magnetic resonance imaging Yuyun Yueniwati, Evelyn Christina Radiology Department, Faculty of Medicine, Brawijaya University, Malang, Indonesia Purpose: To analyze the diagnostic value of MRI for distinguishing tuberculous from pyogenic spondylitis confirmed by histology results and to determine the cut-off point score of MRI.Subjects and methods: Observational analytic design with a cross-sectional approach. Data were collected from radiology and pathology anatomy medical records, therefore no informed consent was obtained. We utilized diagnostic tests using 2×2 tables and receiver operating characteristic curve to obtain the value of the sensitivity, specificity, accuracy, and area under curve (AUC) of MRI. Twenty-eight samples were selected, consisting of 20 samples of tuberculous spondylitis and 8 samples of pyogenic spondylitis.Results: The radiological diagnosis using MRI had a sensitivity of 85%, specificity of 87.5%, positive predictive value of 94.4%, negative predictive value of 70%, and accuracy of 85.7%. AUC value was 91.6%, p = 0.001. MRI with a score ≥4 had sensitivity of 90%, specificity of 87.5%, positive predictive value of 94.7%, negative predictive value of 77.8%, and accuracy of 89.2%.Conclusion: MRI had a high diagnostic value with AUC value of 91.6% for distinguishing tuberculous from pyogenic spondylitis, confirmed by histology results. MRI, with a score of ≥4, had a higher diagnostic value compared with the reading of MRI without using scores. Keywords: histology, MRI, pyogenic spondylitis, tuberculous spondylitis&nbsp