Tc-99m NIDP and Tc-99m HMPAO labelled leukocyte scans in tuberculous spondylitis (original) (raw)
Related papers
Tuberculous Spondylitis: Clinical Features of 36 Patients
Case Reports in Clinical Medicine, 2016
We report 36 cases of spinal tuberculosis who were evaluated at the Internal Medicine Department of Istanbul University between January 1990 and March 2016. Twelve cases were accompanied by active pulmonary tuberculosis while ten patients had a previous history of tuberculosis. Eight patients had diabetes mellitus; six patients were on chronic steroid treatment with a mean dose of 24 mg/day while two patients used azathioprine and methotrexate. The dominant symptom was back pain that was present in 64% of the subjects followed by low grade fever (42%), and malaise (38%). Lytic and destructive lesions were noted in various vertebrae in all of the cases while four patients had spinal compression, and two patients had iliopsoas abscess. The preliminary diagnosis was myeloproliferative disease with vertebral metastasis in eight patients. Tuberculin test was over 15 mm in 20 patients (58.8%) while ERS and Creactive protein were highly elevated in 78%, and 84% of the patients. Diagnosis of tuberculosis was confirmed by culture of aspirated material from intervertebral disc space, collection under CT guidance, sputum or bronchial lavage, and by retrospective anti-tuberculous treatment response. MRI revealed compatible findings with spinal tuberculosis in 30 (80%) patients. In endemic countries, tuberculous spondilitis should be considered in immunosuppressed patients with back pain. Current or past tuberculosis infection is not a reliable indicator for Pott's disease in these patients. Laboratory findings were not usually useful to support the diagnosis. The low sensitivity of the tuberculin test may lead to an erronous diagnosis. Sensitivity of vertebral radiography and CT was low. MRI was the most useful radiologic investigation for the diagnosis of spinal tuberculosis. Tuberculosis of the spine is a diagnostic impasse notably in immunodeficient patients for the clinician.
Annals of Translational Medicine
Background: Tuberculous spondylitis can be difficult to distinguish from alternative spinal pathologies such as malignancy, particularly if the imaging features are not typical. Biopsy and histopathological analysis are facilitative to the early and accurate diagnosis of atypical tuberculous spondylitis and the clinical management. The purpose of this study is to describe some of the atypical imaging features of tuberculous spondylitis diagnosed by image-guided percutaneous biopsy, as well as associated treatment outcomes. Methods: We performed a retrospective analysis of all patients diagnosed with tuberculous spondylitis after image-guided percutaneous biopsy at The Third Affiliated Hospital of Southern Medical University between 2013 and 2020. Of the patients identified, those with atypical imaging features were selected for case review. All patients were given anti-tuberculous medication treatment with or without surgery. The imaging features, histological and microbiological results, and clinical presentations and outcomes were evaluated. Neurological function was evaluated according to the Frankel grading system. The clinical outcomes were evaluated by Visual Analogic Scale (VAS) scores for pain, imaging [X-ray, computed tomography (CT), and magnetic resonance imaging (MRI)] results, and laboratory examinations. Comparison of VAS scores was made by Student t-test. Results: Of the 102 patients identified with tuberculous spondylitis between 2013 and 2020, eight patients (two females and six males) with a mean age of 41.6 years (range, 18-61 years) demonstrated atypical imaging findings, including central vertebral body lesion, multiple skip vertebral lesions, extradural mass lesion and anterior subperiosteal lesion. All eight patients received anti-tuberculous medication treatment, and six underwent surgery. One patient developed a pleural effusion after debridement of the thoracic lesion. The mean follow-up period was 16.2 months (6-37 months). The VAS scores before treatment and at the final follow-up showed significant differences (7.25±1.49 and 0.0±0.0, respectively, P<0.01). Improved neurological function were observed in all patients. Solid fusion and osteogenic osteosclerosis were observed at the final follow-up, and no recurrence was observed in any cases. Conclusions: All eight patients had a good prognosis. Image-guided biopsy and histopathological analysis are helpful for the early diagnosis of tuberculous spondylitis, especially when imaging features are not typical for this condition.
Atypical Imaging Features of Tuberculous Spondylitis: Case Report with Literature Review
Journal of Radiology Case Reports, 2014
Spinal tuberculosis in its typical form that shows destruction of two adjacent vertebral bodies and opposing end plates, destruction of the intervening intervertebral disc and a paravertebral or psoas abscess, is easily recognized and readily treated. Atypical tuberculous spondylitis without the above mentioned imaging features, although seen infrequently, has been well documented. We present, in this report, a case of atypical tuberculous spondylitis showing involvement of contiguous lower dorsal vertebral bodies and posterior elements with paravertebral and epidural abscess but with preserved intervertebral discs. The patient presented in advanced stage with progressive severe neurological symptoms due to spinal cord compression. Non-enhanced magnetic resonance imaging led to misdiagnosis of the lesion as a neoplastic process. It was followed by contrast enhanced computed tomography of the chest and abdomen that raised the possibility of an infectious process and, post-operatively, histopathological examination of the operative specimen confirmed tuberculosis. This case indicates the difficulty in differentiating atypical spinal tuberculosis from other diseases causing spinal cord compression. The different forms of atypical tuberculous spondylitis reported in the literature are reviewed. The role of the radiologist in tuberculous spondylitis is not only to recognize the imaging characteristics of the disease by best imaging modality, which is contrast enhanced magnetic resonance imaging, but also to be alert to the more atypical presentations to ensure early diagnosis and prompt treatment to prevent complications. However, when neither clinical examination nor magnetic resonance imaging findings are reliable in differentiating spinal infection from one another and from neoplasm, adequate biopsy, either imaging guided or surgical biopsy is essential for early diagnosis. CASE REPORT Presentation and Examination A 30 year old female presented to the emergency department with low back pain and bilateral lower limb numbness for 1 month duration. She was pregnant at 37 weeks of gestation. She had no history of trauma, no complaint of fever or weakness and no bladder or bowel dysfunction. On examination, the patient's vital signs were stable, power grade 5/5 in the right lower limb and 4+/5 in the left lower limb, sensation decreased bilaterally, and normal reflexes on both sides. She was admitted for investigations and further evaluation by magnetic resonance imaging (MRI) of the thoraco-lumbar spine. The patient left the hospital against CASE REPORT
Tuberculous spondylitis--analysis of 22 cases
Acta neurologica Belgica, 2009
Tuberculous spondylitis (TS) frequently poses both diagnostic and therapeutic challenges. The clinical symptoms, radiological imaging studies and laboratory tests are quite often inconclusive in the early stages of the disease. To identify early clinical symptoms, review results from radiological imaging studies and laboratory tests to establish their diagnostic value and determine the effect of conservative therapy in patients with early TS. Twenty two (22) patients with TS subjected to conservative therapy were studied. Medullary compression syndrome was found in 10 patients. The highest diagnostic value was established by Magnetic Resonance Imaging (MRI) data for discitis engaging two adjacent vertebrae and QuantiFERON TB Gold and T SPOT.TB tests. The effect of the disease on 12 patients, whose treatment had started before the collapse of the bodies of the vertebrae was non-occurrence of any residual deformity of the spinal column. The effect on 9 patients, whose therapy started ...
A rare widespread tuberculous spondylitis extended from the T5-T10 levels – a case report
IOP Conference Series: Materials Science and Engineering, 2018
Tuberculous spondylitis is an infection of Mycobacterium tuberculosis in the spine and might compromise the vertebrae. Patients often come to treatment at an advanced stage; whilst early diagnosis might be quite tricky. Twenty two years old male patient experienced a weakness, tingling and thickness in both lower limbs that worsened since 1 week before the admission. The imaging results of the multi-slice computed tomography (MSCT) with contrast and X-ray was obtained by impression of pulmonary tuberculosis and lead to the diagnosis of tuberculous spondylitis. Infection developed into a paravertebral abscess in the form of back swelling that is clearly observed at the radiological features with T5-T10 levels of lesion. In this case, neuropathology may be caused by compression of the spinal cord by the abscess; worsened by an ongoing infection and inflammation. Motor deficits might be due to the extended lesion in the anterior horn of the spinal cord; whilst the sensory deficits due to the posterior horn lesion. After medication with anti-tuberculosis and stabilization of the back, patient achieved significant improvement. This underlining the importance of basic anatomy knowledge and its clinical correlation for optimizing patient's diagnosis and treatment.
Diagnostic accuracy of MR imaging in tuberculous spondylitis
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2007
To systemically evaluate MR imaging features of tuberculous spondylitis and to find features that may help differentiating tuberculosis from other spinal diseases. Retrospective review of 65 MR imaging of two groups of patients between January 2002 and December 2005. Thirty-one patients were diagnosed as tuberculosis spondylitis and the rest were a randomly selected group of 34 patients with other spinal diseases. All images were reviewed by two neuroradiologists blinded to clinical data. Sensitivity and specificity of each MR imaging features were calculated. Three most useful MR imaging features with high sensitivity and specificity (> 80%) were endplate disruption (100%, 81.4%), paravertebral soft tissue (96.8%, 85.3%), and high signal intensity of intervertebral disc on T2W (80.6%, 82.4%). High sensitivity but low specificity signs in MRI included bone marrow edema (90.3%, 76.5%), bone marrow enhancement (100%, 42.5%), posterior element involvement (93.5%, 76.5%), canal steno...
Tuberculous spondylodiskitis : about 23 cases
2017
Tuberculous spondylodiskitis is a violation of the intervertebral disc to tuberculosis. This is a rare condition.Aims: of this study is to analyse the clinical profile, the contribution of radiological assessment in the positive diagnosis of evil Pott, and bring different means of confirmation, treatment and evolution of our patients.Methods: It is a study descriptive retrospective from January 2000 to June 2015, we collected 23 observations of evil Pott in the department of pneumology at hospital 20 August from Casablanca.Results: The warning signs are dominated by spinal and chest pain. Eight patients had neurological signs. The diagnosis was made by the detection of Mycobacterium tuberculosis on direct examination and culture in the paravertébral abscess in 7 (3%), by histological examination of discovertebral biopsy in 6 cases (2.6%), biopsy another website tuberculosis in 2 cases and in front of a beam of radio-clinical arguments with good evolution under anti bacillary treatment in 8 cases (3.4%). Surgical drainage was associated in 5 cases (2%). The evolution was good in all cases.Conclusion: The diagnosis of Tuberculous spondylodiskitis may be delayed in the absence of neurological signs, spinal imaging may allow early diagnosis since the introduction of MRI. The prognosis is good when the treatment is early.
MRI characteristics of tuberculous spondylitis
Clinical Radiology, 2011
Spondylitis is the most common osseous manifestation of Mycobacterium tuberculosis infection. Although treatable, it continues to cause significant mortality and morbidity. Early diagnosis through familiarity with its imaging characteristics is essential to permit rapid treatment and prevent potential life-limiting consequences. In this review, we demonstrate the key magnetic resonance imaging features of this disease.
Reports in Medical Imaging
Purpose: To analyze the diagnostic value of MRI for distinguishing tuberculous from pyogenic spondylitis confirmed by histology results and to determine the cutoff point score of MRI. Subjects and methods: Observational analytic design with a cross-sectional approach. Data were collected from radiology and pathology anatomy medical records, therefore no informed consent was obtained. We utilized diagnostic tests using 2×2 tables and receiver operating characteristic curve to obtain the value of the sensitivity, specificity, accuracy, and area under curve (AUC) of MRI. Twenty-eight samples were selected, consisting of 20 samples of tuberculous spondylitis and 8 samples of pyogenic spondylitis. Results: The radiological diagnosis using MRI had a sensitivity of 85%, specificity of 87.5%, positive predictive value of 94.4%, negative predictive value of 70%, and accuracy of 85.7%. AUC value was 91.6%, p = 0.001. MRI with a score ≥4 had sensitivity of 90%, specificity of 87.5%, positive predictive value of 94.7%, negative predictive value of 77.8%, and accuracy of 89.2%. Conclusion: MRI had a high diagnostic value with AUC value of 91.6% for distinguishing tuberculous from pyogenic spondylitis, confirmed by histology results. MRI, with a score of ≥4, had a higher diagnostic value compared with the reading of MRI without using scores.