Diagnostic Approach and Differences between Spinal Infections and Tumors

Abstract

Study design: A systematic review of the literature about differential diagnosis between spine infection and bone tumors of the spine. Background and Purpose: The differential diagnosis between spine infection and bone tumors of the spine can be misled by the prevalence of one of the conditions over the other in different areas of the world. A review of the existing literature on suggestive or even pathognomonic imaging aspects of both can be very useful for correctly orientating the diagnosis and deciding the most appropriate area for biopsy. The purpose of our study is to identify which imaging technique is the most reliable to suggest the diagnosis between spine infection and spine bone tumor. Methods: A primary search on Medline through PubMed distribution was made. We identified five main groups: tuberculous, atypical spinal tuberculosis, pyogenic spondylitis, and neoplastic (primitive and metastatic). For each group, we evaluated the commonest localization, characteristics at CT, CT perfusion, MRI, MRI with Gadolinium, MRI diffusion (DWI) and, in the end, the main features for each group. Results: A total of 602 studies were identified through the database search and a screening by titles and abstracts was performed. After applying inclusion and exclusion criteria, 34 articles were excluded and a total of 22 full-text articles were assessed for eligibility. For each article, the role of CT-scan, CT-perfusion, MRI, MRI with Gadolinium and MRI diffusion (DWI) in distinguishing the most reliable features to suggest the diagnosis of spine infection versus bone tumor/metastasis was collected. Conclusion: Definitive differential diagnosis between infection and tumor requires biopsy and culture. The sensitivity and specificity of percutaneous biopsy are 72% and 94%, respectively. Imaging studies can be added to address the diagnosis, but a multidisciplinary discussion with radiologists and nuclear medicine specialists is mandatory.

Systematic Review and Meta-Analysis on Optimal Timing of Surgery for Acute Symptomatic Metastatic Spinal Cord Compression

“…To minimize the risk of postoperative complications, it is essential to avoid surgery until the patient has undergone appropriate imaging (such as contrast-enhanced CT or MRI) and laboratory tests. These tests are necessary to rule out any underlying conditions or differential diagnoses caused by the primary tumor [25].…”

Malassezia restricta as an unexpected cause of infectious osteomyelitis diagnosed by metagenomic sequencing: a case report and literature review

“…The predominant clinical manifestations of fungal spinal osteomyelitis include local pain, pyrexia, muscular debility, and additional indications of spinal cord compression [ 18 , 19 ]. Findings on imaging typically resemble those of spinal tuberculosis or spinal tumors, characterized by irregular osteolytic destruction of the vertebral bodies, with or without paravertebral abscesses [ 20 ]. After reviewing all English language reports of fungal osteomyelitis involving the spine since 2010, a minimum of 40 related cases were identified (Table 2 ).…”

Differentiation of Native Vertebral Osteomyelitis: A Comprehensive Review of Imaging Techniques and Future Applications

“…The presence of one or more signals in the vertebral body with a subcutaneous-fat-like brightness on the T1WI imaging implies the lesion may be a non-metastatic tumor. The presence of a high-signal rim around a low-signal lesion in the vertebral body on T2WI imaging suggests that the lesion may be a metastatic tumor [ 35 , 36 ]. When the metastatic tumor involves the spinal canal, it is difficult to distinguish it from intraspinal tuberculosis.…”