Non-contrast versus contrast-enhanced MR in the diagnosis of spondylitis: A quantitative concordance-analysis

Abstract

Introduction : Magnetic Resonance (MR) imaging using gadolinium contrast media is an essential imaging modality in diagnosing spondylitis. However, gadolinium contrast is not widely available in Indonesia and relatively expensive. Many MR studies in Indonesia are performed without contrast administration. It is unclear how confident non-contrast MR can diagnose tuberculous spondylitis in comparison to standard contrast MR. Purposes : This study aims to evaluate the concordance between the contrast MR and non-contrast spine MR in diagnosing tuberculous spondylitis. We also evaluate the interobserver agreement between the general radiologist and musculoskeletal radiologist in interpreting non-contrast MR of spondylitis. Materials and Methods : A cross-sectional study using secondary data was performed to evaluate the concordance between the MR results regarding the usage of contrast media in diagnosing spondylitis. The inclusion criteria were patients over 17 years old who underwent complete sequences of contrast-enhanced MR examination of the spine, referred to radiology with the clinical diagnosis of suspected tuberculous spondylitis, spondylodiscitis, or both. All of the non-contrast and contrast-enhanced MR results were read and interpreted by two independent observers, a musculoskeletal radiologist and a general radiologist, blindly. The interobserver agreement analysis of the MR examination was conducted using Kappa and McNemar test. Results : There was no significant difference between the contrast and non-contrast MR in diagnosing spondylitis ( P= 0.368) and no significant difference in the interpretation of MR between the first and the second observer ( P = 0.343). The concordance between the contrast and non-contrast spine MR in diagnosing spondylitis (R: 0.88, P < 0.001) and the interpretation of MR between both observers (R: 0.65, P < 0.001) were showed in this study. Conclusion : There is a high concordance between the contrast and non-contrast MR in diagnosing tuberculous spondylitis. Although contrast MR is preferred as the standard imaging method of spondylitis, in case gadolinium contrast is unavailable, non-contrast MR can still provide valuable information in diagnosing spondylitis.

Magnetic Resonance Imaging (MRI) Images in Tuberculosis Spondylitis Patients at the Central General Hospital Prof. Dr. I.G.N.G. Ngoerah Year 2021-2023

“…This is in line with previous research which found that all research samples experienced endplate disruption. This endplate disruption occurs in the initial phase of the formation of intervertebral disc destruction in the anterior part due to infection which will continue to spread to the lower area to the intervertebral disc (10). This study also showed that all tuberculous spondylitis patients experienced paravertebral abscesses (100%).…”

“…MRI without contrast enhancement can show several observable features including corpus vertebra damage with spinal cord edema, endplate defects, paravertebral and epidural thickening. However, for determining the extent, size and extent of the abscess, it is superior to MRI with contrast enhancement which makes the application of contrast unavoidable for assessing further complications of spondylitis (10).…”

A 27-Year-Old Woman Diagnosed with Tuberculous Spondylitis, or Pott Disease, During Pregnancy: A Case Report

“…MRI plays an important role in the diagnosis of spinal TB in pregnancy. A recent study showed that there was no significant difference between the contrast and non-contrast MRI in diagnosing Pott disease, and concluded that both techniques were equally effective [ 17 ]. In our study, we used post-gadolinium contrast T1-weighted imaging.…”

Review of strategies to reduce the contamination of the water environment by gadolinium-based contrast agents

“…In spine MRI, contrast-enhanced sequences are better in differentiating epidural fibrosis from disc herniation [ 105 ] and for characterisation of vertebral marrow infiltrative lesions [ 106 ]. The added value of GBCA is controversial for the diagnosis of spondylitis and its complications [ 107 ].…”