A Comparative Study Of MRI And DWI In Tuberculous Spondylitis,Brucellar Spondylitis And Pyogenic Spondylitis

Objective To investigate the value of magnetic resonance imaging（MRI）and diffusion-weighted imaging（DWI）in the diagnosis and differential diagnosis of Tuberculous spondylitis（TBS）,Brucellar spondylitis（BS）and Pyogenic spondylitis（PS）.Methods A retrospective analysis of the clinical data of 102 patients with spinal infection diagnosed and treated in the Department of Spinal Orthopaedics,General Hospital of Ningxia Medical University from January 2017 to January 2020,including 43 cases of TBS,36 cases of BS,and 23 cases of PS.The clinical data of the three groups were compared and analyzed,including general conditions,laboratory tests,routine MRI and DWI data,and measured the ADC values of the three groups of normal vertebral bodies,diseased vertebral bodies and paravertebral abscesses when the diffusion sensitivity coefficient（b value）is 500s/mm².Results 1.There were significant differences among the three groups in thoracic involvement,lumbar involvement,vertebral bone destruction,intervertebral stenosis,paravertebral abscess,and vertebral collapse（P<0.05）;among them,the overall rate of TBS is higher in thoracic involvement,vertebral bone destruction,severe intervertebral stenosis,paravertebral abscess and vertebral collapse,with statistically significant difference（P<0.0167）.2.When b=500 s/mm²,the average ADC values of normal vertebral bodies,diseased vertebral bodies,and paravertebral abscesses in the three groups are as follows:TBS:（0.45±0.07）×10^-3mm²/s,（1.27±0.13）×10^-3mm²/s,（1.66±0.16）×10^-3mm²/s;BS:（0.45±0.05）×10^-3mm²/s,（1.17±0.13）×10^-3mm²/s,（1.56±0.13）×10^-3mm²/s;PS:（0.43±0.05）×10^-3mm²/s,（1.21±0.16）×10^-3mm²/s,（1.55±0.12）×10^-3mm²/s.The ADC values of diseased vertebral bodies and paravertebral abscesses in the three groups were statistically significant（P<0.05）,while the ADC values of normal vertebral bodies were not statistically significant（P>0.05）,the ADC values of diseased vertebral bodies and paravertebral abscesses in TBS were higher than those in the other two groups.Conclusion TBS,BS and PS have different characteristics in the aspect of vertebral bone destruction,intervertebral stenosis,vertebral collapse and paravertebral abscess,which are helpful for the diagnosis of three diseases;The sensitivity of DWI is high,and the ADC values can quantify different pathological changes.Routine MRI combined with DWI can provide a certain reference value for the diagnosis and differential diagnosis of spinal infectious diseases.