MAGNETIC RESONANCE IMAGING FINDINGS FEATURES FOR DIFFERENTIATING TUBERCULOUS AND PYOGENIC SPONDYLODISCITIS

Objectives: Differentiating tuberculous spondylodiscitis (TBSD) from pyogenic spondylodiscitis (PSD) remains a diagnostic challenge due to the low positivity rates in microbiological and histopathological tests. This study aimed to determine MRI imaging features that can help distinguish between TBSD and PSD.Methods: A retrospective study was conducted on patients diagnosed with SD (either by microbiological, histopathological findings, or treatment response), who had undergone contrast-enhanced MRI scans of the spine before treatment. Imaging features on MRI were described and compared between TBSD and PSD group.Results: A total of 65 patients were studied, including 23 (35.4%) with TBSD and 42 (64.6%) with PSD. Of the 13 MRI features analyzed, 8 showed significant differences between the two groups (p<0.05). Features indicative of TBSD: Thoracic spine involvement (OR=8.073), vertebral body destruction >50% height loss (OR=21.867), presence of intraosseous abscess (OR=4.604), disc preservation (OR=8.217), thin and smooth-walled paravertebral abscess (OR=11.511). Features indicativeof PSD: Lumbar-sacral spine involvement (OR=5.681), epidural abscess formation (OR=7.752), thick and irregular-walled paravertebral abscess (OR=21.739).Conclusion: Several MRI features can help differentiate between TBSD and PSD, guiding appropriate treatment selection, particularly when microbiological confirmation is unavailable.