The Value Of DWI Combined With DCE-MRI In The Differential Diagnosis Of Tuberculous Spondylitis And Brucellar Spondylitis

Objective: To investigate the value of diffusion weighted imaging(DWI)combined with dynamic contrast enhanced magnetic resonance imaging(DCE-MRI)in differential diagnosis of tuberculous spondylitis(TS)and brucellar spondylitis(BS).Methods: A total of 66 patients with spinal infectious diseases diagnosed by epidemiological history,laboratory examination,imaging examination and(or)pathological analysis were collected,including TS group(n = 37)and BS group(n = 29).All patients underwent plain MRI scan,DWI and(or)DCE-MRI examination before operation.The region of interest(ROI)was drawn on DWI and DCE-MRI images,and the quantitative parameters of ADC histogram(10th percentile,25 th percentile,50 th percentile,75 th percentile,90 th percentile,average,minimum,maximum,median,standard deviation,skewness,kurtosis and heterogeneity)and semi-quantitative parameters of DCE-MRI(time to peak TTP,maximum relative enhancement rate MRE,wash in rate WIR)were extracted.The parameters of TS group and BS group were compared by independent sample t test or Mann Whitney U test,and ROC curves were drawn to analyze the efficacy of parameters with statistical differences in distinguishing TS from BS.Logistic regression analysis was used to further combine the parameters and then draw the ROC curve to analyze its diagnostic efficiency.Result: There were significant differences in ADC histogram quantitative parameters ADC90,ADCmax,ADCSt Dev,Skewness and DCE-MRI semi-quantitative parameters MRE between TS group and BS group(P < 0.05).The area under curve(AUC),sensitivity and specificity of the ADCmax and MRE were 0.771,54.05%,93.10% and 0.776,76.47%,73.33%,respectively.The AUC,sensitivity and specificity of the combined parameter ADCmax + MRE are 0.820、70.59%、86.67%,respectively.There was no significant difference between the AUC of combined parameter ADCmax + MRE and that of ADCmax and MRE alone(P > 0.05).Conclusion: The quantitative parameters of ADC histogram(ADC90,ADCmax,ADCSt Dev,Skewness)and the semi-quantitative parameter of DCE-MRI(MRE)have certain reference value for the diagnosis and differential diagnosis of TS and BS.Among them,the diagnostic efficiency of ADCmax and MRE is relatively high,and the combination of them can improve the diagnostic efficiency.