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- Title
Whole Spine Magnetic Resonance Imaging Findings Are Highly Sensitive In The Diagnosis Of Spinal Tuberculosis.
- Authors
Shetty, Ajoy; Kanna, Rishi Mugesh; Maheswaran, Anupama; Bhari, Pushpa; Rajasekaran, S.
- Abstract
Introduction: Tubercular (TB) culture and histopathological evidence are considered as gold standard tests to confirm the diagnosis of spinal tuberculosis. The diagnostic utility of whole spine MRI findings has not been analysed in comparison to tissue studies. Materials and Methods: We prospectively studied 68 consecutive patients with spondylodiscitis. All patients had MRI of the whole spine and biopsy for tissue GeneXpert test, histopathological examination (HPE) & tuberculous culture. Based on the results, patients were divided into two groups - confirmed TB (Group A) with positive tubercular culture and or positive HPE for tuberculosis and non-TB (Group B), when both culture and HPE were negative. Positive HPE for TB was based on presence of epitheloid granulomas and multi-nucleated giant cells. MRI features considered characteristic of TB included multi-level lesion (> 3 vertebra - contiguous and non-contiguous), intra-osseous abscess and extensive abscess formation (multi-loculated, long segment abscess, circumferential abscess) and bilateral psoas abscess. The sensitivity, specificity, predictive value of MRI findings and GeneXpert test was studied between the two groups. Results: The mean age of the patients was 48.6 ± 18.3 years with a male: female distribution of 29:39. In 22 patients, the lesion was at thoracic spine (T1-T11); 19 patients had affliction at thoraco-lumbar region (T12-L1); 18 in the lumbar and sacral region and 9 in the other regions of the spine. Fifty two patients underwent surgical treatment and the remaining 16 had been treated non-operatively. Among 68 patients, 49 had confirmed TB (Group A) (23 by positive TB culture, 26 by positive HPE and 14 with both culture and HPE positive). The remaining Group B had 19 patients, including 8 pyogenic infections, 3 pathological fracture, and 8 inconclusive reports. The GeneXpert was positive in 39 cases (31 in group A and 8 in Group B) with a sensitivity of 63%, specificity of 58%, positive predictive value of 79% and negative predictive value of 38%. MRI was positive in 50 patients (42 in group A and 8 in Group B) with a sensitivity of 85%, specificity of 58%, PPV of 84% and NPV of 61%. MRI features diagnostic of tuberculosis included a combination of extensive abscess formation (n = 42), intraosseous abscess (n = 9), Multi-level lesions (n = 25) and psoas abscess (n = 23). All group A patients showed good healing of the lesion at the completion of anti-tubercular chemotherapy and there were no cases of treatment failure or relapse within a one year follow-up period. Among the 39 patients with positive GeneXpertest, all showed sensitivity to Rifampicin except 2 patients. Conclusion: MRI plays an important role in the diagnosis of spinal TB similar to chest radiograph for pulmonary TB, but often under appreciated. We observed that whole spine MRI findings including multi-level skipped lesions, extensive abscess formation, and bilateral psoas abscess had very good sensitivity (85%) to diagnose tuberculosis while GeneXpert test had only moderate sensitivity and specificity. Thus MRI findings in combination with tissue examination (HPE, culture and GeneXpert test) are important elements for diagnosing spinal TB.
- Publication
Global Spine Journal, 2018, Vol 8, p287S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/2192568218771072