Brucellar and tuberculous spondylitis: comparative imaging features.

Abstract

Radiographs, scintigrams, computed tomographic scans, and magnetic resonance (MR) images of 17 patients with brucellar spondylitis and 15 with tuberculous spondylitis were analyzed to identify distinguishing features. Characteristic findings of brucellar spondylitis included predilection for the lower lumbar spine (68% of lesions), bone destruction limited to the end plates, disk collapse (16 of 19 disks), and granulation tissue or localized soft-tissue edema (17 of 19 sites). MR imaging showed diffuse increased signal in vertebrae and disks on long repetition time (TR)/echo time (TE) images in four patients and focal increased signal with normal disks in one. Epidural extension was best seen on short TR/TE images in four. Tuberculous spondylitis was characterized by predilection for the midthoracic spine (73%), vertebral destruction with gibbus deformity (60%), disk collapse, and paraspinal abscesses (14 of 15). On MR images signal intensity of affected vertebrae was similar to but more severe than findings in patients with brucellar spondylitis. Scintigraphy was the least helpful in differentiating the two infections. Lesions of tuberculous spondylitis affecting the lower lumbar spine were difficult to differentiate from those of brucellar spondylitis.

Brucellar spondylitis: a rare cause of spinal cord compression

“…Clinical and radiological diagnoses of brucellar spondylitis may be difficult, since brucellar spondylitis may resemble many diseases that affect the spine, such as tuberculosis, pyogenic osteomyelitis, intervertebral disc herniation, and malignancy. [5][6][7] Delayed diagnosis leads to increased morbidity. In our case, the delay in diagnosis was 6 months due to misdiagnosis of malignancy, tuberculosis, and pneumonia.…”

Lumbar epidural abscess caused by brucella species: report of two cases

“…Imaging studies for Brucella spondylitis do not give clues about definitive diagnosis 3,12 . Biopsy or surgical intervention is indicated to rule out other granulomatous lesions like tuberculosis when the diagnosis is indefinite despite neuroradiological and clinical studies 9,12 .…”

Brucellar Spine Infection-Four Case Reports-

“…19) The lumbosacral region is most frequently involved in spondylodiscitis, followed by the thoracic and cervical segments. 2,3,7,9,19,22,24,27) Brucellar spondylodiscitis is frequently characterized by involvement of the cartilage endplate, an area with a rich blood supply, in the early stages of the disease. 2,4,7,21,24) Spinal extradural or paravertebral abscess formation is an extremely rare presentation of Brucella involvement.…”

“…Although involvement of the spine may have widely variable and nonspecific manifestations, more widespread use of current diagnostic studies such as computed tomography (CT) and magnetic resonance (MR) imaging has allowed more accurate and frequent detection of spinal brucellosis. 6,10,12,13,17,22) In this study, we present our experience of spinal brucellosis in four cases treated in our institution over a period of 5 years.…”