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Magnetic resonance imaging features for differentiating tuberculous from pyogenic spondylitis: a meta-analysis

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Abstract

Objective

To perform a meta-analysis comparing the MRI features of tuberculous and pyogenic spondylitis, using histopathological results and/or blood culture as the standard reference.

Materials and methods

PubMed, Embase, Web of Science, and Cochrane Library were searched for English-language studies on the MRI features of tuberculous and pyogenic spondylitis published between January 2010 and February 2023. Risk for bias and concerns regarding applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled MRI features’ proportions were calculated using a bivariate random-effects model.

Results

Thirty-two studies met the inclusion criteria: 21 for tuberculous spondylitis, three for pyogenic spondylitis, and eight for both. Of the nine informative MRI features comparing tuberculous spondylitis to pyogenic spondylitis, involvement of ≥ 2 vertebral bodies (92% vs. 88%, P = .004), epidural extension (77% vs. 25%, P < .001), paravertebral collection (91% vs. 84%, P < .001), subligamentous spread (93% vs. 24%, P < .001), thin and regular abscess wall (94% vs. 18%, P < .001), vertebral collapse (68% vs. 24%, P < .001), and kyphosis (39% vs. 3%, P < .01) were more suggestive of tuberculous spondylitis, while disc signal change (82% vs. 95%, P < .001) and disc height loss (22% vs. 59%, P < .001) were more suggestive of pyogenic spondylitis.

Conclusion

Involvement of ≥ 2 vertebral vertebral bodies, soft tissue attribution, thin and regular abscess wall, vertebral collapse, and kyphosis were MRI features more common in tuberculous spondylitis, while disc signal change and height loss were more common in pyogenic spondylitis.

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Abbreviations

TbS:

Tuberculous Spondylitis

PyS:

Pyogenic Spondylitis

CI:

Confidence interval

QUADAS:

Quality Assessment of Diagnostic Accuracy Studies

I2 :

Inconsistency index

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Author notes

  1. Wang Zhi-Tao and Wang Zhong-Qiu contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No. 155, Hanzhong Road, Nanjing, 210029, Jiangsu Province, China

    Chen Ling-Shan, Li Jing, Zhao Rui, Ling Li-Fang, Wang Zhi-Tao & Wang Zhong-Qiu

  2. Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China

    Zhu Zheng-Qiu

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Ling-Shan, C., Zheng-Qiu, Z., Jing, L. et al. Magnetic resonance imaging features for differentiating tuberculous from pyogenic spondylitis: a meta-analysis. Skeletal Radiol 53, 697–707 (2024). https://doi.org/10.1007/s00256-023-04459-5

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