Primary Discitis And Initial Tuberculosis Of Spine A Comparative Image Features Analysis

Objective: To de$termine if radiography, computed tomographic (CT), and magnetic resonance imaging (MRI) findings can help differentiate primary discitis from initial tuberculosis of spine.Methods: Imaging studies in 40 patients with primary discitis which is confirmed by histopathology (case 38) and clinical follow-up (case 2) (25 radiography, 28 CT, and 36 MRI) and 39 with spine tuberculosis which is confirmed by histopathology (case 37) and clinical follow-up (case 2) (25 radiography, 24 CT, and 30 MRI). To compare clinical, laboratory, and radiological features of primary discitis and tuberculosis of spine.Results: Spinal lesions in primary discitis are more frequent in elderly men (male: female ratio, 3:1), while most spine tuberculosis affected a younger age group (male:female ratio, 1:1.6). Primary discitis most commonly affected the lower lumbar spine, especially in the L4-5(15/41), whereas spine tuberculosis was most common in thoracic and lumber spine, especially thoracic-lumber part (T10-L3). The symptom duration of spine tuberculosis was more longer than primary discitis and often more than 1 year, whereas the symptom duration of primary discitis was less than 3 months. There are no obviously differences in clinical and laboratory, but in our study, high fever is more common in primary discitis (12/29) than in spine tuberculosis (1/12), elevated white cell is more common in primary discitis (12/26) than in spine tuberculosis (2/33). There is no difference in erythrocyte sedimentation rate. The most helpful differences between them were end-plate sclerosis and end-plate destruction in radiogram, osteophyte formation and affected vertebral body deformity in radiograms and CT scan. Thoracic vertebrae involved, affected multiple vertebral body, longitudinal ligament spread, and paraspinanl abscess in MRI was most important signs in tuberculosis of spine. We also analysed the affected disc signal intensity in T2WI, the extent of high signal in T2WI from the affected vertebral body. The contrast enhancement of MRI shown differences, such as primary discitis shown diffuse enhancenment in the vertebral body, disc, and paraspinal soft tissue, whereas the spine tuberculosis shown rim-enhancement after cold-abscess formed, the wall was thin and homogeneous.Conclusion: The imaging (X, CT, MRI) can mostly differentiate primary discitis and tuberculosis of spine. The patternern of MRI enhancement was much more helpful to differentiate them.