31 March 2024: Review Articles
Differentiation of Native Vertebral Osteomyelitis: A Comprehensive Review of Imaging Techniques and Future Applications
Weijian Zhu 12BCEF , Sirui Zhou 3D , Jinming Zhang 1D , Li Li 4B , Pin Liu 2A , Wei Xiong 1A*DOI: 10.12659/MSM.943168
Med Sci Monit 2024; 30:e943168
Introduction
Segmental Structure of the Spine
Diagnostic Value of Plain Radiographs and Computed Tomography for NVO
Diagnostic Value of MRI in NVO
Pyogenic Spondylitis
Tuberculous Spondylitis
Brucellar Spondylitis
Fungal Spondylitis
Diagnostic Value of Positron Emission Tomography for NVO
Artificial Intelligence Applications and the Future
Conclusions
References
Table 2 Application of magnetic resonance imaging in native vertebral osteomyelitis.
| Authors | Year | Sample size | Disease conditions | Research purposes | Results |
|---|---|---|---|---|---|
| Frel et al []24 | 2017 | 34 | The median age was 61.5 years in the PS group and 52 years in the TS group/3 months – 1 year for PS group, 5 months – 1 year for BS group | Identify and differentiate MRI image features of TS and PS | PS showed homogeneous diffuse enhancement of the vertebral body, and TS showed focal inhomogeneous enhancement of the vertebral body. TS had a higher incidence of paravertebral soft tissue swelling, epidural swelling, and meningeal enhancement |
| Lee et al []31 | 2018 | 69 | Median age 60 years in the PS group and 57 years in the TS group | Differentiation of PS from TS | MRI images of TS show a heterogeneous pattern of enhancement of the vertebral body and are often accompanied by a marginally enhanced abscess, with the disc usually relatively preserved. MRI images of PS usually show the following features: the vertebral body shows a homogeneous pattern of enhancement, and the disc may be affected |
| Galhotra et al []27 | 2015 | 50 | 10 weeks | To explore the potential of MRI in the diagnosis of NVO, especially its accuracy in identifying TS and PS | Vertebral destruction is usually at grade 3 (25%–50% vertebral destruction) or higher in TS and usually no more than 25% in PS. loss of cortical contour is more common in TS than PS. vertebral enhancement patterns are usually localized and inhomogeneous, and diffuse and homogeneous in TS vs PS, respectively |
| Gupta et al []29 | 2023 | 90 | The delayed diagnosis for the TS group was 105 days | Identify image features that help differentiate PS from TS | TS is more common in the thoracic spine and is often accompanied by a paraspinal abscess with a well-defined wall and central liquefaction. TS can lead to destruction of the intervertebral discs to a degree greater than 50%.TS can lead to a reduction in the height of the vertebral body, with a reduction in the height of the L2 vertebrae of more than 25% of the L3 vertebral body. TS can lead to vertebral body deformities. PS can occur in any part of the spine, including the cervical, thoracic, and lumbar spine, and is often accompanied by involvement of posterior structures, such as the arch and the lamina, etc. PS can lead to deformities of the spine |
| Naselli et al []28 | 2021 | 114 | Average age 60 years | Exploring the value of MRI examination combined with epidemiologic data for the differential diagnosis of TS and PS | In TS compared with PS, involvement of posterior structures was more common (93.3% versus 52.4%), discontinuity of spinal involvement was more common (26.6% versus 3.6%), the thoracic spine region was significantly more prevalent than in pyogenic spondylitis (60% versus 38.1%), having more than 2 vertebrae involved was more common (60% versus 16.7%), and the intra-vertebral bone abscess versus the paravertebral abscess had a ratio TS is high, and extra vertebral abscesses are more common in PS. Contrast enhancement of TS vertebrae usually shows heterogeneity |
| Batirel et al []42 | 2015 | 314 | Average age 51±18 years/median of 78 days | Describe the clinical, laboratory, diagnostic and therapeutic features of TS | TS leads to a decrease in disc height and the patient experiences lysogenic changes in the bony ends of the vertebrae, which may lead to infection and abscess formation in the paravertebral tissues, usually involving multiple vertebrae, with the most common sites of involvement being the thoracic and lumbar spine |
| Kanna et al []39 | 2019 | 150 | Average age 51 years | Describe the diagnostic features of TS at the pro-histologic level with imaging | Imaging features of TS include involvement of more than two adjacent vertebrae, presence of fluid or abscesses within the vertebral body or in adjacent paravertebral soft tissues, changes in anterior bone signal and expansion of abscesses to the level of more than two vertebrae, disruption of the vertebral body with a reduction of more than half of its height, expansion of the abscess beyond one vertebral body, abscess wall thickness of less than 2 mm (greater than 2 mm is considered thick walled), involvement of non-adjacent vertebral bodies at different sites at different vertebral levels, alterations in the morphology of the discs, which are isointense with the fluid signal, vertebral end-plate margins irregularities, which may be observed on T2WI/STIR images, and erosion or compression of epidural tissues by the abscesses or granulation tissue |
| Liang et al []51 | 2019 | 67 | The mean age of the patients was 50.5±10.2 years old | Describe the epidemiologic features and imaging characteristics of BS | Imaging features of BS include lumbar spine involvement in 81.2%, MRI can show paraspinal and epidural abscesses, paraspinal abscesses in 20.9% of patients and epidural abscesses in 10.4% of patients, and abscesses and areas of lesions in BS show irregular and marked enhancement on MRI |
| Li et al []33 | 2018 | 64 | Mean age 55 years in the PS group and 57 years in the BS group/Interval between onset and radiographs, mean 6 weeks in the PS group and 9 weeks in the BS group | To investigate the accuracy of MRI in identifying PS and BS | Differences between PS and BS: diffuse, partial, and scalloped high signal on median sagittal fat suppression-weighted images (PS: 51, 11, 3/65 vs BS: 35, 18, 19/72); vertebral plate disruption (PS: 9/43 vs BS: 27/35); extensive vertebral plate disruption (PS: 29/43 vs BS: 8/35); distensibility changes of the intradural intervertebral space (PS: 7/32 vs BS: 0/32); inflammatory response lines starting from the vertebral body plate (PS: 30/65 vs BS: 1/72); signs of disc encroachment (PS: 1/28 vs BS: 12/33); inflammatory response lines within the intervertebral discs (PS: 5/28 vs BS: 25/33); and severe intravertebral space disruption (PS: 17/28 vs BS: 12/33) |
| Hammami et al []25 | 2021 | 117 | Mean age 49±19 years in the TS group and 50±16 years in the BS group/Duration of symptoms, 17±12 weeks in the BS group and 21±15 weeks in the TS group | Compare the clinical, laboratory, imaging and evolutionary features of TS and BS | TS usually erodes the thoracic spine, while BS usually erodes the lumbar spine. TS usually shows multiple bone destruction and disc destruction, while BS usually shows localized bone destruction and limited paravertebral soft-tissue involvement. TS shows low signal of the vertebral body, especially in the anterior corners on the T1WI images, while BS shows relatively high signal on the T1WI images. TS usually shows low signal in the anterior corners and the posterior-superior corners of the vertebral body, while BS shows low signal in the anterior corners of the vertebral body. signal in the anterior and posterior-superior corners of the vertebral body, whereas BS exhibits low signal in the anterior corners of the vertebral body. The intervertebral discs of TS exhibit high signal on T2WI images, whereas the intervertebral discs of BS have relatively low signal |
| Liu et al []50 | 2018 | 67 | Interval between patient’s visit and onset of illness | Revealing MRI features of BS with TS in acute and subacute phases | The signal intensity of BS vertebrae was more homogeneous than that of TS vertebrae on fat suppression T2WI, and TS showed an increase in signal intensity of vertebrae on fat suppression T2 WI, which was nearly inhomogeneous |
| Koubaa et al []49 | 2013 | 32 | Mean age of patients 51±15 years/Median 90 days | Evaluate the clinical, laboratory, and imaging manifestations and outcomes of BS. | In acute BS, MRI shows low signal intensity on T1WI images of the intervertebral disc and adjacent vertebrae. The signal in these areas becomes high signal intensity on T2WI MRI sequences, which can have a homogeneous or inhomogeneous pattern. Intravenous injection of gadolinium allows for better definition of inflammatory spinal lesions and more complete assessment of soft tissue involvement and epidural extent. These features are best displayed when fat suppression techniques are applied to the enhanced images |
| Yang et al []52 | 2014 | 63 | Evaluation of MRI in patients with BS | Assessment of image characteristics of MRI in patients with BS | In the acute stage, MRI shows low signal intensity on T1WI images and high signal intensity on T2WI images over the vertebral body, intervertebral discs and vertebral endplates. In the subacute and chronic stages, MRI showed low signal intensity on T1WI images and heterogeneous high signal intensity on T2WI images. Contrast-enhanced images show contrast enhancement of the intervertebral disc and affected vertebrae in the acute, subacute, and chronic stages. Soft tissue swelling and paravertebral abscess formation may be observed. Lesions in BS are usually solitary but may be multiple and multi-segmental. |
| Crete et al []44 | 2017 | 41 | Average age is 42 years | Describes coccidian infections resulting from various spinal manifestations and provides examples of MRI | Fungal spondylitis shows enhancement over the spinal cord membranes, usually diffuse, and can affect the cervical, thoracic, and caudal cones/cauda equina uniformly. Adhesive inflammation appears over the spinal cord membranes, commonly in the lumbar spine, and manifests as nerve root masses. Adhesive arachnoiditis can also occur in the cervical and thoracic spinal cord. Spinal cord edema was observed in 11 patients. True spinal cord cavitation was observed in 3 patients. 14 patients had vertebral osteomyelitis and/or discitis. Common presentations included paravertebral involvement, intervertebral disc involvement, bone destruction, and skip lesions in noncontiguous vertebrae. Intracerebral lesions were present in all patients with extramedullary lesions, of which 27 patients underwent brain MRI, and another 3 patients showed posterior cranial fossa involvement by cervical spine MRI, of which 19 patients demonstrated basal-only or basal-dominant meningeal enhancement |
| Lee et al []53 | 2013 | 60 | Average age 56±18 years | Median 4 months, 1 month and 5 months for fungal spondylitis, PS and TS groups, respectively | In fungal spondylitis, disc destruction was seen in 50% of patients, compared to 93% of patients in PS and 28% of patients in TS. In fungal spondylitis and PS, the infection was more extensive and involved a greater number of vertebrae, whereas in TS the infection was less extensive. Inflammatory masses in fungal spondylitis showed low signal intensity on T2WI imaging, whereas in PS inflammatory masses showed high signal intensity on T2WI imaging. Inflammatory masses in TS showed low or high signal intensity on T2WI imaging. Abscess formation was less common in fungal spondylitis and more common in PS and TS |
| MRI – magnetic resonance imaging; PS – pyogenic spondylitis; TS – tuberculous spondylitis; T1WI – T1-weighted image; T2WI – T2-weighted image; MRI – magnetic resonance imaging; BS – brucellar spondylitis; STIR – short Tau inversion recovery. | |||||