MRI And Pathological Discrimination Of Early Spine Infections

BACKGROUNDWith the wide use of antibiotics, typical cases of pyogenic spondylitis is relatively rare in the domestic, increased the difficulty of early diagnosis.Brucellosis is a zoonotic infectious disease caused by Brucella coli, spine vulnerable to invasion and then developed into brucella spondylitis. Tuberculosis, although often occurred in the respiratory system, joint tuberculosis is not uncommon, spine for its most commen position, accounting for50%of the total number of joint tuberculosis. Early spinal inflammation on the radiographic and clinical manifestations have many similarities, but the three treatment is completely different. So the correct early diagnosis and differential diagnosis, timely and effective intervention, can significantly reduce the probability of patients with spinal deformity and function damage. Nowadays, pathology examination has as a routine examination method in the clinical application and MRI for its precise display, well soft tissue and multi-dimensional imaging is the first choice for the spine infection. For this reason, the author propose by observing the pathological tissue microstructure features and MRI signs change, to explore pathology and the value of MRI in early spine infection differential diagnosis.OBJECTIVETo determine the accuracy of pathology and MRI for discrimination in early spinal infections by observing the pathological tissue microstructure features and MRI signals. METHODS22patients with pyogenic spondylitis,20patients with brucella spondylitis and20patients with tuberculosis spondylitis who had CT-guided percutaneous biopsy and MRI of the spine were retrospectively reviewed. Pathological observations included structure and activity of bone lesions, tissue cells and their main components; MRI observations included signal and sign changes at lesion sites. Analysis the constituent ratio of the three groups pathological results and MRI findings. Statistical analysis was performed with the chi-square test.RESULTSThe patients with pyogenic spondylitis had a significantly higher incidence of pathological and MRI findings as follows (P<0.05):neutrophil infiltration in main; intervertebral disc abnormal signal, location of vertebral body lesions anterior+posterior, Thick and irregular abscess wall. The patients with brucella spondylitis had a significantly higher incidence of pathological and MRI findings as follows (P<0.05): Lymphocyte infiltration in main, New bone tissue, Epithelioid granuloma tissue, Location of vertebral body lesions anterior, No obviously shape change in the vertebral body, No obviously paraspinal abnormal signal, No presence of intraosseous or paraspinal abscess,Thin and irregular abscess wall; The patients with tuberculosis spondylitis had a significantly higher incidence of pathological and MRI findings as follows (P<0.05):Dead bone tissue, Langerhans giant cells, caseous necrosis, Lesion in lower thoracic vertebra, No intervertebral disc abnormal signal, location of vertebral body lesions posterior, obviously shape change in the vertebral body, paraspinal abnormal signal, presence of intraosseous or paraspinal abscess, Thin and smooth abscess wall.CONCLUSIONPathological and MRI examination was accurate for early differentiation of pyogenic spondylitis from brucella spondylitis. The method is more helpful to the diagnosis of bacterial culture negative spondylitis patients.