Atypical Disseminated Skeletal Tuberculosis Mimicking Metastasis on PET-CT and MRI

Go, Seong Woo; Lee, Hea Yon; Lim, Chae Hun; Jee, Won-Hee; Wang, Young-Pil; Yoo, Ie Ryung; Kang, Ji Young

doi:10.2169/internalmedicine.51.8347

Cited by 25 publications

(16 citation statements)

References 13 publications

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“…For TB, when the tuberculous abscess has not yet formed or when the tuberculosis has not involved the intervertebral disk, the paraspinal lesion shows as a solid mass and it may be mis-diagnosed as malignant. When a lesion manifests as vertebral bone destruction, local mass, absence of disc involvement or abscess, the plain pre-contrast scan and static post-contrast enhancement will be difficult to distinguish between tuberculous granulomas and soft tissue mass of metastases [1–3]. In general, it is difficult to differentiate between benign and malignant musculoskeletal lesions in the spine [4–10].…”

Section: Discussionmentioning

confidence: 99%

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Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI

et al. 2015

Eur Spine J

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Purpose To investigate the differences between imaging features of spinal tuberculosis (TB) and metastatic cancer measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The presentation of TB on convention MRI may not show the typical TB signs, and they may be mis-diagnosed as malignant diseases. DCE-MRI may provide additional information to help making differential diagnosis. Materials and methods DCE-MRI was performed in 24 TB and 22 metastatic cancer patients. The DCE kinetic pattern was determined as “wash-out”, “plateau” or “persistent enhancement”. The characteristic DCE parameters were calculated from the signal intensity time course. The two-compartmental pharmacokinetic model was used to obtain Ktrans, which is the parameter associated with the delivery of MR contrast agents into the lesion, and kep, which is the parameter associated with the distribution and clearance of contrast agents from the lesion. Results Of the 24 TB, one case showed the wash-out kinetic pattern, 12 cases showed the plateau pattern, and 11 cases showed the persistent enhancement pattern. Of the 22 metastatic cancers, 12 cases showed wash-out, 7 cases showed plateau, and 3 cases showed persistent enhancement patterns. Compared to the metastatic cancer group, the TB group had a lower kep (0.27±0.15 vs. 0.49±0.23 min−1, P<0.001). The ROC analysis showed that the area under the curve was 0.780 for kep. Conclusions DCE-MRI may provide additional information for differentiation between spinal TB and metastasis, when their manifestations on conventional imaging were similar.

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Section: Discussionmentioning

confidence: 99%

“…Also, they may cause similar symptoms to patients, mostly pain. Because these two diseases require very different treatments, the correct preoperative diagnostic imaging would tremendously help the determination of the suitable procedures to be performed next and the optimal treatment methods [1–3]. …”

Section: Introductionmentioning

confidence: 99%

Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI

et al. 2015

Eur Spine J

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“…Spinal metastatic tumor and spinal tuberculosis are common diseases of the spine ( 1 ). The typical manifestations of spinal tuberculosis are vertebral bone destruction, intervertebral disc space reduction and paravertebral abscess; and the manifestations of spinal metastatic tumor typically include bone destruction and presence of a soft tissue mass, which rarely invades the intervertebral disc ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Differential study of DCE-MRI parameters in spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis

Qiao

Zhao

Gao

et al. 2018

Chinese Journal of Cancer Research

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ObjectiveIn the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis were quantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to assess the value of DCE-MRI in the differential diagnosis of these diseases.MethodsPatients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor (30 cases of each) received conventional MRI and DCE-MRI examination. The volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular volume fraction (Ve) and plasma volume fraction (Vp) of the diseased vertebral bodies were measured on the perfusion parameter map, and the differences in these parameters between the patients were compared. ResultsFor pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis, respectively, the Ktrans values (median ± quartile pitch) were 0.989±0.014, 0.720±0.011 and 0.317±0.005 min–1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min–1; the Ve values were 0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; the corresponding H values were 50.25 (for Ktrans), 52.47 (for Kep), 48.33 (for Ve) and 46.56 (for Vp), and all differences were statistically significant (two-sided P<0.05). ConclusionsThe quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis.

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“…The diagnosis of multifocal osteoarticular TB is often delayed due to the clinical and radiological resemblance of the disease to numerous malignant and bone diseases (6,7). The consequences of considerable diagnostic delays in multifocal osteoarticular TB can prove critical for patients, since such delays may lead to the spread of the infection from the bone to the adjacent joints and surrounding soft tissue, causing significant functional disabilities (8,9).…”

Section: Introductionmentioning

confidence: 99%

Multifocal osteoarticular tuberculosis of the extremities in an immunocompetent young man without pulmonary disease: A case report

Guo

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Osteoarticular tuberculosis (TB), an uncommon form of extrapulmonary TB, is a universal mimicker and thus represents a potential differential diagnosis of any osteolytic lesion. The present study describes a case of multifocal osteoarticular TB in an immunocompetent young man who presented with swelling and extremity pain. The patient underwent plain radiography, bone scan and magnetic resonance imaging. A diagnosis was ultimately made based on the pathology results from his second left toe. The patient responded well to anti-TB medication. The radiological findings of multifocal osteoarticular TB are described in this report. To the best of our knowledge, this is the first reported case of multifocal osteoarticular TB symmetrically affecting all the extremities.

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Atypical Disseminated Skeletal Tuberculosis Mimicking Metastasis on PET-CT and MRI

Cited by 25 publications

References 13 publications

Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI

Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI

Differential study of DCE-MRI parameters in spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis

Multifocal osteoarticular tuberculosis of the extremities in an immunocompetent young man without pulmonary disease: A case report

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