Imaging-Assisted Diagnosis and Characteristics of Suspected Spinal Brucellosis: A Retrospective Study of 72 Cases

Abstract

BackgroundWe clarified the imaging features of Brucella spondylitis to enhance our understanding of the disease and to minimize misdiagnosis.Material/MethodsImaging data (X-ray, computed tomography [CT], and magnetic resonance imaging [MRI] data) of 72 Brucella spondylitis patients treated from 2010 to 2017 were retrospectively analyzed; diagnoses was made by evaluating laboratory and pathological data.ResultsX-ray films revealed changes in intervertebral space heights, the number of lateral osteophytes, and bone destruction, which were more severe in the following order: lumbosacral vertebrae (56 cases, 77.8%), cervical spine (6 cases, 8.3%), thoracic spine (5 cases, 6.9%), and multi-segmental mixed vertebrae (5 cases, 6.9%). CT revealed osteolytic destruction attributable to early-stage Brucella spondylitis (endplate and vertebral lamellar osteolysis), usually associated with multiple vertebral involvement, with the middle and late disease stages being characterized by osteophytes in the vertebral margins and bony bridges, endplate sclerosis, and vertebral osteosynthesis. We encountered 54 cases (75%) with endplate lamellar osteolysis, 37 (51.4%) with vertebral lamellar osteolysis, 59 (81.9%) with marginal osteophytes, 10 (13.9%) with bony bridges, 25 (34.7%) with vertebral laminar sclerosis, and 17 (23.6%) with vertebral osteosynthesis. MRI revealed early, low-intensity, differential T1WI vertebral and intervertebral signals, with occasional iso-signals, T2WI iso-signals or high-intensity signals; and T2WI-FS vertebral and intervertebral high-intensity signals, commonly from vertebral soft tissues and rarely from paravertebral abscesses.ConclusionsA better understanding of the X-ray, CT, and MRI features of Brucella spondylitis could aid in diagnosis when combined with epidemiological and laboratory data, thus minimizing misdiagnosis.

<p>Spinal brucellosis in Hulunbuir, China, 2011–2016</p>

“…Brucellar spondylodiscitis (BS) is the involvement of the vertebral column, interspinal spaces, and/or paraspinal areas. In China, only limited reports described the spinal brucellosis thus far, which were mainly focused on the application of MRI imaging in the diagnosis of BS 18–21. In this study, we analyzed the epidemiologic, clinical, and laboratory data, as well as the treatment and outcome characteristics of 67 cases with BS for the first time.…”

Knockdown of Mg2+/Mn2+ dependent protein phosphatase 1A promotes apoptosis in BV2 cells infected with Brucella suis strain 2 vaccine

“…Phagocytic cells are the main host and Brucella can inhibit apoptosis of these cells ( 23 ). In the absence of effective antibiotics treatment, 50% of brucellosis cases become chronic and cause multiple organ damage, including neurological disorders, bone destruction and cardiovascular damage ( 24 , 25 ). Meningitis is a common cause of fatality in brucellosis ( 26 , 27 ).…”

Gout involved the cervical disc and adjacent vertebral endplates misdiagnosed infectious spondylodiscitis on imaging: case report and literature review

“…Bone destruction, dead bone, narrowing of intervertebral space, angulate deformity and cold abscess are the hallmarks of the disease and can help differentiate it from other conditions, and paraspinal collection occurs more commonly than in pyogenic infection and may be bilateral and disproportionately larger than the degree of bone destruction [26, 27]. In the cases of spinal brucellosis, the principal features in the sclerotic period are vertebral body hyperplasia, osteophyte proliferation, bony spines resembling “bird beaks” (that sometimes forms bony bridges) and endplate sclerosis; paraspinal soft tissue shadows and predural granulomas are more common than usual, and paravertebral abscesses are less common [27]. The main radiological differentiation factors between these conditions is the characteristics of the osteolytic lesions and changes of paravertebral tissues.…”