Jurnal Spondilytis Tb

J Med Assoc Thai Vol. 90 No. 8 2007 1581

Correspondence to : Chiewvit P, Department of Radiology,Faculty of Medicine, Siriraj Hospital, 2 Prannok Rd,Bangkoknoi, Bangkok 10700, Thailand. Phone: 0-2419-8079,Fax: 0-2419-412-7787

Diagnostic Accuracy of MR Imaging inTuberculous Spondylitis

Nasuda Danchaivijitr MD*, Siriwan Temram MD*,Kullathorn Thepmongkhol MD*, MSc*, Pipat Chiewvit MD*

* Department of Radiology, Siriraj Hospital, Mahidol University

Objective: To systemically evaluate MR imaging features of tuberculous spondylitis and to find features thatmay help differentiating tuberculosis from other spinal diseases.Material and Method: Retrospective review of 65 MR imaging of two groups of patients between January2002 and December 2005. Thirty-one patients were diagnosed as tuberculosis spondylitis and the rest were arandomly selected group of 34 patients with other spinal diseases. All images were reviewed by twoneuroradiologists blinded to clinical data. Sensitivity and specificity of each MR imaging features werecalculated.Results: Three most useful MR imaging features with high sensitivity and specificity (> 80%) were endplatedisruption (100%, 81.4%), paravertebral soft tissue (96.8%, 85.3%), and high signal intensity of intervertebraldisc 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 stenosis (87.1%, 26.5%), and spinal cord or nerve root compression (80.6%, 38.2%). Low sensitivitybut high specificity features in MRI were intervertebral disc enhancement (63.3%, 84.2%), vertebral collapse(58.1%, 85.3%), and kyphosis deformity (67.7%, 82.4%). Overall, the sensitivity and specificity of MRI forspinal tuberculosis were 100% and 88.2% respectively.Conclusion: The authors presented three good to excellent sensitivity and specificity MR imaging features forspinal tuberculosis, end plate disruption, paravertebral soft tissue formation, and high signal of intervertebraldisc on T2W. In contrast to a previous study, most of the presented cases still presented with classic radiologicalpictures of “two vertebral disease with the destruction of the intervertebral disc”. Only a small portion of thepatients revealed sparing intervening disc or isolated single vertebral body involvement, which possiblyreflected the early stages of the disease process.

Keywords: Tuberculosis, Spondylitis, Magnetic resonance imaging

Spinal tuberculosis is the most common siteof osseous involvement in tuberculosis. The diseaseprevalence will continue to rise as the number ofimmunocompromised patients increases. Neurologicalcomplications occur in about 10% of patients and canbe devastating. Paraplegia may be a result of spinalcord compression from liquid or caseous pus, inflam-matory granulation tissue of active disease or kypho-

sis deformity in the late state of disease(1). Therefore,early diagnosis and establishment of treatment arenecessary for avoiding this long-term disability.

Magnetic resonance imaging is currently amodality of choice for the evaluation of a potentialspinal infection(2-6). Advantages of MR imaging includethe capacity of multiplanar imaging, direct evaluationof the bone marrow and contemporary visualizationof the neural structures(7). Typical radiolographicchanges of two adjacent vertebral bodies with destruc-tion of the intervertebral disc and a presence of para-vertebral abscesses are easily appreciated and usually

J Med Assoc Thai 2007; 90 (8): 1581-9Full text. e-Journal: http://www.medassocthai.org/journal

1582 J Med Assoc Thai Vol. 90 No. 8 2007

prompt antituberculous treatment(8). However, atypicalappearance on MR imaging such as involvement of asingle vertebra or isolated involvement of posteriorelements, although occur less frequently, is less recog-nized, but has been well documented(8-10). Other commonspinal diseases such as degenerative disc disease withassociated endplate edema, spinal metastasis, inflam-matory spondyloarthropathy, and erosive intervertebralosteochondrosis may occasionally mimic radiographicappearance of spinal tuberculosis. Hence, the authorsconducted the present study to systematically evaluateMR imaging features of tuberculous spondylitis andto find features that may help differentiating tuber-culosis from other spinal diseases.

Material and MethodThe authors retrospectively reviewed spinal

MR imaging and plain radiography of spines (whenavailable) obtained during January 2002 to December2005. A total of 65 MR imaging was included, in which31 patients were diagnosed as tuberculous spondylitisand the rest was a randomly selected group of 34patients with other spinal conditions (degenerativespondylitis 24 patients (70.6%), spinal metastasis 3cases (8.8%), benign compression fracture 2 cases(5.8%), pyogenic spondylitis 2 cases (5.8%), multiplemyeloma 2 cases (5.8%) and hemangioma 1 case (2.9%)).Of the 31 patients with tuberculous spondylitis, 18 pa-tients (58.1%) were diagnosed based on the presenceof histopathological or microbiological evidence and13 patients (41.9%) were diagnosed based on typicalradiological findings with good response to antituber-culous treatment.

The present study was conducted after ap-proval was obtained from Siriraj Hospital’s review boardto review patient images and medical chart record. Theboard determined that this retrospective study couldbe conducted without requiring a signed informed con-sent from the patients.

All MR Imaging was performed with 1.5 TeslaMRI scanner. Sagittal T1-Weighted spin echo and T2-Weighted spin echo and axial T2-Weighted spin echowere acquired in all cases. In addition, T1-Weightedwith fat saturation in sagittal and axial planes wereobtained after intravenous administration of gadopen-tetate (Gd-DTPA) where infection or tumor processesare suspected. All of the presented spinal tuberculosiscases were given gadolinium injection.

Two trained neuroragiologists reviewed allMR Imaging independently and were blinded to theclinical data. In case of disagreement, the final judg-

ments were rendered by a consensus.Plain radiography was evaluated for the

present of bony destruction, bony sclerosis, end platedisruption, pedicle destruction, intervertebral discspace, and paravertebral soft tissue. On MR imagingvarious features of the imaging findings were evaluated,including signal intensity of the involved vertebralmarrow and intervertebral disc on T1W, T2W and con-trast-enhanced images, destruction of the vertebralbodies and vertebral end plate, extent of the vertebralbody involvement, paraspinous soft tissue mass orabscess formation, degree of spinal canal compromisewith or without cord or nerve root compression andalignment of the spine.

Data analysisSensitivity and specificity of each imaging

signs described above were calculated. Interobserveragreements were calculated with Kappa statistic (pooragreement = 0; slight, agreement = 0.01-0.20; fair agree-ment = 0.21-0.40; moderate agreement = 0.41-0.60; goodagreement = 0.61-0.80; and excellent agreement = 0.81-1.00)(11).

ResultsThe tuberculosis spondylosis group con-

sisted of 19 males (61.2%) and 12 females (38.7%); agerange, 16-83 years; mean age, 59 years. Whereas, thenon-tuberculosis group consisted of 21 males (61.7%)and 13 females (38.2%); age range, 35-84 years; meanage, 61 years. There was no significant differencebetween sex and age between the two groups.

Most common presenting neurological symp-toms were back or neck pain. Among these, tuberculo-sis patients also presented with paraplegia in 12 cases(38.7%), whereas non-tuberculosis patients only hadassociated radiculopathy without cord compression in11 cases (32.4%). Thoracic spine was the most com-mon site of spinal TB involvement followed by lumbarand cervical. Sacrum was not involved in any spinalTB cases (Table 1).

Spinal regions

CervicalThoracicLumbarSacrum

TB (91)

8 (8.8%)49 (53.8%)34 (37.4%) 0

Non TB (94)

32 (34.0%) 10 (10.6%) 46 (48.9%) 6 (6.4%)

Table 1. Site of spinal involvement


Radiographs of the spine were available in 57cases. Endplate destruction and vertebral body destruc-tion were the most two useful signs in plain radiographfor diagnosing tuberculous spondylitis with highsensitivity and specificity (> 79%). Presence of para-vertebral soft tissue and pedicle destruction had highspecificity but low sensitivity, whereas decreasedheight of intervertebral disc had high sensitivity butlow specificity. Overall, the sensitivity and specificityof plain radiography were 82.8% and 89.3% respec-tively (Table 2).

MRI features with high sensitivity and speci-ficity (> 80%) were endplate disruption (100%, 81.4%),paravertebral soft tissue (96.8%, 85.3%) and highsignal intensity of intervertebral disc on T2W (80.6%,82.4%).

High sensitivity but low specificity signs inMRI included bone marrow edema (90.3%, 76.5%), bonemarrow enhancement (100%, 42.5%), posterior elementinvolvement (93.5%, 76.5%), canal stenosis (87.1%,26.5%), and spinal cord or nerve root compression(80.6%, 38.2%). Low sensitivity but high specificityfeatures in MRI were intervertebral disc enhancement(63.3%, 84.2%), vertebral collapse (58.1%, 85.3%), and

kyphosis deformity (67.7%, 82.4%). Details of sensi-tivity and specificity of each MRI feature were shownin Table 3.

Destruction of the posterior elements werefound in spinal tuberculosis in 29 cases (93.6%), inwhich pedicles were the most frequently affected site(27 cases (93.1%)).

Overall, the sensitivity and specificity ofMRI for spinal tuberculosis were 100% and 88.2%respectively. Interobserver agreement (k statistics) onMRI findings was 0.94.

DiscussionThe symptoms and clinical findings in patients

with spinal infection are often non-specific and mayvary widely, depending on the site, extent, and severityof the pathological process(5,6,12). Especially, tubercu-losis infection is more indolent with a gradual onset ofsymptoms over months to years. Cases with spinaland radicular pain without fever often are diagnosederroneously as disc protrusions.

In the present study, patients with tubercu-losis spondylitis had more clinical severity and moreoften presented with paraplegic complication. This

Plain radiography Findings

Endplate disruptionBody destructionParavertebral soft tissueDecreased disc heightPedicle destructionSclerosis

TB

25231824 818

Non TB

5 4 018 2 8

Sensitivity

86.2% 79.3% 62.1% 82.8% 27.6% 62.1%

Specificity

82.1% 85.7% 100.0% 35.7% 92.9% 71.4%

Table 2. Plain radiography findings with sensitivity and specificity of each sign

MRI Findings

Endplate disruptionHigh SI of disc, T2WDisc enhancementParavertebral soft tissue/abscessBone marrow enhancementBone marrow edemaPosterior element involvementCanal stenosisSpinal cord compressionVertebral collapseKyphosis

TB

3125193030312927251821

Non TB

6 6 3 51112 82521 5 6

Sensitivity

100% 80.6% 63.3% 96.8% 100% 90.3% 93.5% 87.1% 80.6% 58.1% 67.7%

Specificity

81.4% 82.4% 84.2% 85.3% 42.5% 76.5% 76.5% 26.5% 38.2% 85.3% 82.4%

Table 3. MR imaging findings with sensitivity and specificity of each feature


probably reflects rapid disease progression during theacceleration phase or a delay in detecting the disease.Spinal cord compression due to vertebral body collapseor epidural inflammatory tissue and vascular impair-ment can deteriorate spinal cord functions(13). The on-set of paraplegia depends on the rapidity of increase ofcord compression mechanism and in spinal tubercu-losis the spinal canal can tolerate 50 to 76% of canalstenosis before neural deficit appears(14). This findingemphasized the importance of early disease detectionand accuracy of imaging findings interpretation.

Thoracic spine is frequently reported as themost common site of involvement in spinal tubercu-losis(15-19), followed by lumbar and cervical spines, re-spectively. The present results are consistent withother previous studies, in which thoracic and lumbarspines involvement together contributed at least 90%of the cases. Multifocal spinal TB was reported toaccount for 1-24% of the cases(15,16,20-22). In the presentstudy, the number of multiple vertebral body involve-ment (> 3 vertebral bodies) was significantly higher(36%).

On spinal plain radiography, the most com-mon early findings were narrowing of the disc spaceand vertebral osteolysis. Then followed by paraverte-bral shadow, vertebral collapse, and angulation of thespine in advanced cases(23). The present study showedthat plain radiography could identify vertebral bodydestruction and disc involvement with overall fairsensitivity (82.8%) and specificity (89.3%) (Fig. 1). Othersigns on plain films were reactive sclerosis, vertebralcollapse, gibbus deformity, and vertebral fusion, whichare findings of the advanced cases(24). It is worth men-tioning that these abnormalities may not be visible onplain radiography for up to 8 weeks(6,25-27).

Magnetic resonance imaging (MRI) is theinvestigation method of choice for the diagnosis ofspondylodiscitis because it presents some advantagesincluding high sensitivity in early stages, better defi-nition of paravertebral and epidural extension, spinalcord involvement and the possibility of distinguishingtubercular infection from those of other origin(6,28).MRI is also the best procedure for differentiating typi-cal and atypical spinal TB. Previous literatures showedvarying frequencies of these two distinct patternsacross studies(6,25,29-31).

An increasing number of atypical formscharacterized by spondylitis without disc involvement,were reported and even claimed to be the most com-mon pattern of spinal TB type in foreign-born subjectsin industrialized countries(32). In the present series,

Fig. 1 (a, b) A 57-year-old man presented with low backpain with paraplegia, lateral view (a) and anterior-posterior view (b) of plain lumbar spine radiographreveals anterior-superior end plate destruction ofL2 vertebral body with markedly reduced L1-2intervertebral disc height and surrounding sclerosis(grey arrows), minimal degree of lateral subluxationand scoliosis is present of AP view, surroundingbony sclerosis and small bony fragment adjacent tothe involved area is noted, subtle paraspinal softtissue shadows bilaterally are also noted (whitearrows)

Fig. 2 Tuberculosis spondylitis of T8-9, (a, b, c) Magneticresonance image of the thoracic spine in a 58-year-old woman presented with back pain, (a) Pre-Gado-linium T1-Weighted in sagittal plane (b) T2-weightedin sagittal plane (c) post-Gadolinium T1-Weightedin sagittal plane show typical pattern of two vertebralbodies destruction with intervening disc involvement,linear high signal intensity of disc on T2-weightedimages is well appreciated (white arrow), afterGadolinium enhancement, there is enhancement ofthe involved vertebra including posterior element,irregular rim enhancing intervertebral disc is present(white arrow heads), collapse of T8 vertebra is noted


may lose its nutrition and involved secondarily(24).Three most useful MRI features with high specificityin the present study were in keeping with the previouspurposed disease process where endplate disruptionis the most sensitive sign followed by paravertebralsoft tissue formation and high signal of intervertebraldisc on T2W. Other signs are less sensitive and lessspecific because other disease processes can producethe same appearance.

Destruction of the end plates is consideredtypical for disc infection(2,3,5,12). However, some authorsreported intact endplates on both sides of an infecteddisc and lack of endplates involvement can thereforenot be use as a reliable sign to exclude spinal infec-tion(33-35). Pseudosparing of the endplate due to chemi-cal shift artifact can be avoided by means of selectionof the phase-encoding plane in the craniocaudal direc-tion(36).

Presence of paravertebral soft tissue in pre-vious spinal TB reports varied from 80 to 98%(37,38). Inthe present series, most of the cases with paraspinalmass also had typical spondylitis features. Six caseshad normal appearance of intervertebral discs and onlyone case with single vertebra was affected without discinvolvement. This may indicate early state of infectionand the fact that disease process has originate fromthe vertebral end plate and then spread into sub-liga-mentous route and form a paravertebral soft tissuemass or abscess. In these cases, it is possible that thedisease process had not yet spread into the interven-ing disc.

High signal in disc on T2W and disc enhance-ment are considered typical for spinal infection butnot specific for TB(39, 40). It also can be seen in otherconditions such as highly vascularized degenerativediscs in erosive intervertebral osteochondritis(7). Highsignal disc on T2W were seen in all of the presentedcases with disc involvement. Again, normal signal ofdisc was seen in seven cases. Six patients with discinvolvement did not show disc enhancement. A lackof enhancement of infected discs was reported tooccur rarely(33,40).

Differentiating spinal TB from pyogenicspondilitis is usually difficult, although there are manyprevious claims that there may be some features help-ful. Clinically, TB infection generally affects adults infourth and fifth decades whereas peak incidence ofpyogenic spondyloitis is seen in the sixth or seventhdecades(24). The smooth margin of a cold abscess fromTB, which is sub-ligamental spread without destructionof the paraspinal ligament, contrasts with the irregular

classic tuberculosis spondylitis features, whichshowed involvement of at least two adjacent vertebralbodies, abnormalities of the intervening disc and para-spinal soft tissue formation, are still the most commonpattern of spinal TB found in 23/31 (74.2%) cases (Fig. 2).Atypical form which was characterized by spondylytiswithout disc involvement(32) were present in sevencases (22.6%) (Fig. 3). Among these, single vertebrainvolvement was found in only one case (3.2%). Theexplanation could be due to most patients having moresevere disease or late diagnosis.

In the early state, infection usually originatesat the anterior sub-chondral bone adjacent to thevertebral end plates. Then, it spreads underneath thelongitudinal ligament, mostly anterior longitudinalligament, followed by adjacent vertebra or multiplevertebral bodies and discs involvement. When both ofthe neighboring vertebral bodies are involved, the disc

Fig. 3 Atypical findings of tuberculosis spondylitis of T7,(a, b) Magnetic resonance image of the thoracicspine in a 69-year-old woman presented with backpain and paraplegia (a) precontrast T1-weighted insagittal plane (b) T2-weighted in sagittal plane showsignal change of bone marrow edema of T7 vertebralbody with minimal decrease vertebral body height,convex of posterior border of verebral body causecentral canal stenosis and mild cord compression arenoted (white arrow), high signal of the spinal cord,just superior to the infected vertebral is detected(white arrow head), note preservation of the adja-cent intervertebral disc, these findings may difficultto differentiate with the neoplasm process


margin of pyogenic abscesses, which proteolytic en-zyme can destroy the paraspinal ligament(28). Posteriorelements or multiple vertebral body involvement are lesscommonly encountered in pyogenic spondilitis(2,41-43).In addition, size of the paraspinal mass is larger in tu-berculosis than in pyogenic infections(43,44). Collapse ofthe vertebral bodies is rarely seen in pyogenic spinalinfection but common in spinal TB(4,45). In the chronicstage, tubercular spondylitis shows a slightly hyper-intense signal of vertebral body on T1-Weighted images,whereas the non-tuberculous spondylitis shows low-signal intensity(6,46). Nonetheless, by using thesesigns in the present series, the authors were still un-able to differentiate bacterial spondylitis from spinalTB (Fig. 4). However, the number of patients with pyo-genic spongylitis in the present study is small. Furtherstudy is required to evaluate this topic in more detail.

Isolated involvement of the posterior elementswith sparing of the vertebral body, a feature that aremore typical of neoplasm than infection process, doesoccur in spinal TB especially in countries where TB isepidemic(24,47). However, this finding was not foundin the present study, where all of the presented casesthat had posterior involvement also had vertebralbody and intervertebral disc involvement and could bedifferentiated from neoplasm.

Some limitation applies to the present study.Since most of the control group in the present study is

degenerative spinal disease, which sometimes is rathereasy to differentiate from spinal TB. This may haveled to overestimation of sensitivity and specificity ofsome signs. However, the most common condition tobe encountered in real practice is degenerative disease,which is somewhat similar to the present study popu-lation. Therefore, the statistical values in the presentstudy may still be applicable. Another limitation isthat the gold standard of diagnosing TB (histology ormicrobiology) from clinical specimen is not available inevery case. This may again have led to a contamina-tion of non-TB diseases in the TB group. Nevertheless,a diagnosis of TB spine without histology or micro-biology may still be valid since the acid-fast bacillusis not seen in over 50% of the histological section(1).

ConclusionThe authors presented three good to excellent

sensitivity and specificity MR imaging features forspinal tuberculosis; end plate disruption, paravertebralsoft tissue formation, and high signal of intervertebraldisc on T2W. In contrast to a previous study(32), mostof the presented cases still presented with classicradiological pictures of “two-vertebral disease with thedestruction of the intervertebral disc”. Only a smallportion of the patients revealed sparing interveningdisc or isolated single vertebral body involvement,which possibly reflected the early stages of the

Fig. 4 Bacterial spondylitis of L4-5 (a, b, c) Magnetic resonance image of the lumbar spine in a 64-year-old man presentedwith back pain and leg weakness, (a) pre-Gadolinium T1-weighted in sagittal plane (b) T2-weighted in sagittal plane(c) Post-Gadolinium T1-weighted in sagittal plane show classical findings of spondylitis with involvement ofintervening disc which can not be differentiated from tuberculous spondylitis (white arrow), linear dark line of theposterior longitudinal ligament on both T1-weighted and T2-weighted images is not well demonstrated and possibledestroy by bacterial proteolytic enzyme (arrow heads)


disease process. Differentiating TB spondylitis frompyogenic spondylitis with radiological findings aloneis usually difficult and not reliable.

AcknowledgementsThis study was funded by the Faculty of

Medicine, Siriraj Hospital, Mahidol University. Theauthors wish to thank Dr. Chotipat Danchaivijitr forhis assistance in the preparation of the manuscript.

References1. Luk KD. Spinal tuberculosis. Curr Opin Orthop

2000; 11: 196-201.2. Modic MT, Feiglin DH, Piraino DW, Boumphrey F,

Weinstein MA, Duchesneau PM, et al. Vertebralosteomyelitis: assessment using MR. Radiology1985; 157: 157-66.

3. Post MJ, Quencer RM, Montalvo BM, Katz BH,Eismont FJ, Green BA. Spinal infection: evalua-tion with MR imaging and intraoperative US.Radiology 1988; 169: 765-71.

4. Sharif HS. Role of MR imaging in the managementof spinal infections. AJR Am J Roentgenol 1992;158: 1333-45.

5. Thrush A, Enzmann D. MR imaging of infectiousspondylitis. AJNR Am J Neuroradiol 1990; 11:1171-80.

6. Maiuri F, Iaconetta G, Gallicchio B, Manto A,Briganti F. Spondylodiscitis. Clinical and magneticresonance diagnosis. Spine 1997; 22: 1741-6.

7. Stabler A, Reiser MF. Imaging of spinal infection.Radiol Clin North Am 2001; 39: 115-35.

8. Naim uR. Atypical forms of spinal tuberculosis. JBone Joint Surg Br 1980; 62-B: 162-5.

9. Chapman M, Murray RO, Stoker DJ. Tuberculosisof the bones and joints. Semin Roentgenol 1979;14: 266-82.

10. Ragland RL, Abdelwahab IF, Braffman B, MossDS. Posterior spinal tuberculosis: a case report.AJNR Am J Neuroradiol 1990; 11: 612-3.

11. Landis JR, Koch GG. An application of hierarchicalkappa-type statistics in the assessment of majorityagreement among multiple observers. Biometrics1977; 33: 363-74.

12. Meyers SP, Wiener SN. Diagnosis of hemato-genous pyogenic vertebral osteomyelitis by mag-netic resonance imaging. Arch Intern Med 1991;151: 683-7.

13. Mushkin AY, Kovalenko KN. Neurological com-plications of spinal tuberculosis in children. IntOrthop 1999; 23: 210-2.

14. Jain AK, Aggarwal A, Mehrotra G. Correlation ofcanal encroachment with neurological deficit intuberculosis of the spine. Int Orthop 1999; 23: 85-6.

15. Colmenero JD, Jimenez-Mejias ME, Sanchez-LoraFJ, Reguera JM, Palomino-Nicas J, Martos F, et al.Pyogenic, tuberculous, and brucellar vertebralosteomyelitis: a descriptive and comparative studyof 219 cases. Ann Rheum Dis 1997; 56: 709-15.

16. Hayes AJ, Choksey M, Barnes N, Sparrow OC.Spinal tuberculosis in developed countries: diffi-culties in diagnosis. J R Coll Surg Edinb 1996; 41:192-6.

17. Nussbaum ES, Rockswold GL, Bergman TA,Erickson DL, Seljeskog EL. Spinal tuberculosis:a diagnostic and management challenge. JNeurosurg 1995; 83: 243-7.

18. Rezai AR, Lee M, Cooper PR, Errico TJ, KoslowM. Modern management of spinal tuberculosis.Neurosurgery 1995; 36: 87-97.

19. Weaver P, Lifeso RM. The radiological diagnosisof tuberculosis of the adult spine. Skeletal Radiol1984; 12: 178-86.

20. Buchelt M, Lack W, Kutschera HP, KatterschafkaT, Kiss H, Schneider B, et al. Comparison of tuber-culous and pyogenic spondylitis. An analysis of122 cases. Clin Orthop Relat Res 1993; 192-9.

21. Cotten A, Flipo RM, Drouot MH, Maury F,Chastanet P, Duquesnoy B, et al. Spinal tuber-culosis. Study of clinical and radiological aspectsfrom a series of 82 cases. J Radiol 1996; 77: 419-26.

22. Lindahl S, Nyman RS, Brismar J, Hugosson C,Lundstedt C. Imaging of tuberculosis. IV. Spinalmanifestations in 63 patients. Acta Radiol 1996;37: 506-11.

23. Ansari S, Ashraf AN, Moutaery KA. Spinal infec-tions: a review. Neurosurg Q 2001; 11: 112-23.

24. Tali ET. Spinal infections. Eur J Radiol 2004; 50:120-33.

25. al Mulhim FA, Ibrahim EM, el Hassan AY,Moharram HM. Magnetic resonance imaging oftuberculous spondylitis. Spine 1995; 20: 2287-92.

26. Ridley N, Shaikh MI, Remedios D, Mitchell R.Radiology of skeletal tuberculosis. Orthopedics1998; 21: 1213-20.

27. Naim uR, Jamjoom A, Jamjoom ZA, Al Tahan AM.Neural arch tuberculosis: radiological featuresand their correlation with surgical findings. Br JNeurosurg 1997; 11: 32-8.

28. Narlawar RS, Shah JR, Pimple MK, Patkar DP,Patankar T, Castillo M. Isolated tuberculosis ofposterior elements of spine: magnetic resonance


imaging findings in 33 patients. Spine 2002; 27:275-81.

29. Fam AG, Rubenstein J. Another look at spinaltuberculosis. J Rheumatol 1993; 20: 1731-40.

30. Kim NH, Lee HM, Suh JS. Magnetic resonanceimaging for the diagnosis of tuberculous spondy-litis. Spine 1994; 19: 2451-5.

31. Liu GC, Chou MS, Tsai TC, Lin SY, Shen YS. MRevaluation of tuberculous spondylitis. Acta Radiol1993; 34: 554-8.

32. Pertuiset E, Beaudreuil J, Liote F, Horusitzky A,Kemiche F, Richette P, et al. Spinal tuberculosisin adults. A study of 103 cases in a developedcountry, 1980-1994. Medicine (Baltimore) 1999; 78:309-20.

33. Dagirmanjian A, Schils J, McHenry M, Modic MT.MR imaging of vertebral osteomyelitis revisited.AJR Am J Roentgenol 1996; 167: 1539-43.

34. Michael AS, Mikhael MA. Spinal osteomyelitis:unusual findings on magnetic resonance imaging.Comput Med Imaging Graph 1988; 12: 329-31.

35. Ledermann HP, Schweitzer ME, Morrison WB,Carrino JA. MR imaging findings in spinal infec-tions: rules or myths? Radiology 2003; 228: 506-14.

36. Wolansky LJ, Heary RF, Patterson T, FriedenbergJS, Tholany J, Chen JK, et al. Pseudosparing ofthe endplate: a potential pitfall in using MR imag-ing to diagnose infectious spondylitis. AJR Am JRoentgenol 1999; 172: 777-80.

37. Alothman A, Memish ZA, Awada A, Al MahmoodS, Al Sadoon S, Rahman MM, et al. Tuberculousspondylitis: analysis of 69 cases from Saudi Arabia.Spine 2001; 26: E565-E570.

38. Andronikou S, Jadwat S, Douis H. Patterns ofdisease on MRI in 53 children with tuberculousspondylitis and the role of gadolinium. Pediatr

Radiol 2002; 32: 798-805.39. Modic MT, Pavlicek W, Weinstein MA,

Boumphrey F, Ngo F, Hardy R, et al. Magneticresonance imaging of intervertebral disk disease.Clinical and pulse sequence considerations.Radiology 1984; 152: 103-11.

40. Post MJ, Sze G, Quencer RM, Eismont FJ, GreenBA, Gahbauer H. Gadolinium-enhanced MR inspinal infection. J Comput Assist Tomogr 1990;14: 721-9.

41. de Roos A, van Persijn van Meerten EL, Bloem JL,Bluemm RG. MRI of tuberculous spondylitis. AJRAm J Roentgenol 1986; 147: 79-82.

42. Price AC, Allen JH, Eggers FM, Shaff MI, JamesAE, Jr. Intervertebral disk-space infection: CTchanges. Work in progress. Radiology 1983; 149:725-9.

43. Smith AS, Weinstein MA, Mizushima A, CoughlinB, Hayden SP, Lakin MM, et al. MR imagingcharacteristics of tuberculous spondylitis vs ver-tebral osteomyelitis. AJR Am J Roentgenol 1989;153: 399-405.

44. Sharif HS, Aideyan OA, Clark DC, Madkour MM,Aabed MY, Mattsson TA, et al. Brucellar andtuberculous spondylitis: comparative imagingfeatures. Radiology 1989; 171: 419-25.

45. Sharif HS, Clark DC, Aabed MY, Haddad MC, alDeeb SM, Yaqub B, et al. Granulomatous spinal in-fections: MR imaging. Radiology 1990; 177: 101-7.

46. Bruns J, Maas R. Advantages of diagnosing bac-terial spondylitis with magnetic resonance imag-ing. Arch Orthop Trauma Surg 1989; 108: 30-5.

47. Sharif HS, Morgan JL, al Shahed MS, al ThagafiMY. Role of CT and MR imaging in the manage-ment of tuberculous spondylitis. Radiol ClinNorth Am 1995; 33: 787-804.


ความแมนยำในการวนจฉยผปวยโรควณโรคกระดกสนหลงดวยเครองสนามแมเหลกไฟฟา

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วตถประสงค: เพอหาลกษณะผดปกตทางภาพแมเหลกไฟฟาของกระดกสนหลงทมลกษณะเฉพาะสำหรบผปวยวณโรคกระดกสนหลงเปรยบเทยบกบผปวยโรคกระดกสนหลงอน ๆวสดและวธการ: การศกษายอนหลงภาพแมเหลกไฟฟาของกระดกสนหลงของผปวย 2 กลมในชวงป พ.ศ. 2545 -พ.ศ. 2548 กลมแรกเปนผปวยวณโรคกระดกสนหลงจำนวน 31 คน สวนกลมทสองเปนผปวยโรคกระดกสนหลงอน ๆ ทสมเอาในชวงเวลานนจำนวน 34 คน ภาพแมเหลกไฟฟาถกแปลผลโดยรงสแพทยผเชยวชาญดานระบบประสาท 2 ทานซงไมทราบถงประวตของผปวยมากอนผลการศกษา: พบวาภาพแมเหลกไฟฟาของกระดกสนหลงท มลกษณะคอนขางไวและจำเพาะตอโรควณโรคกระดกสนหลงไดแก การทำลายของแผนปลายประสาทเคลอนไหวของกระดกสนหลง (ความไว 100%, ความจำเพาะ81.4%), การมกอนหรอฝหนองทบรเวณรอบกระดกสนหลง (ความไว 96.8%, ความจำเพาะ 85.3%), และสญญาณทเพมขนของหมอนรองกระดกสนหลง (ความไว 80.6%, ความจำเพาะ 82.4%), สวนลกษณะผดปกตรปแบบอน ๆบางรปแบบกมความไวแตไมมความจำเพาะ บางรปแบบมความจำเพาะแตไมมความไวสรป: การศกษานพบวาลกษณะเฉพาะบางอยางของวณโรคกระดกสนหลงทตรวจพบดวยเครองแมเหลกไฟฟามความไวและความจำเพาะสง นอกจากนผปวยวณโรคกระดกสนหลงในการศกษานสวนใหญยงมความผดปกตของกระดกสนหลงแบบตรงตนแบบ ซงแตกตางจากการศกษาอนซงพบวาไมมการทำลายของหมอนรองกระดกสนหลงเปนสวนใหญ

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