Differentiation of typical features between Fungal spondylitis and Brucellar spondylitis on CT and new applications of CT values in diagnosis of spinal infections.

Abstract

Purpose: The low positive rate of microorganism culture and nonspecific clinical manifestations increase the difficulty of diagnosing spinal infection. To date, no studies have reported differences in radiological manifestations between fungal spondylitis (FS) and brucellar spondylitis (BS). This may lead to severe misdiagnosis. In this study, we aimed to investigate the typical radiological features of these two types of spondylitis and evaluate the application of computed tomography (CT) values in their diagnosis.

Methods: A total of 59 elderly patients with 119 infected vertebrae were included. 44 patients with 91 infected vertebrae were included in the BS group, and 15 patients with 28 infected vertebrae were included in the FS group. Differences in radiological features and parameters were compared by using the Mann-Whitney U test, χ² test or Fisher's exact test. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficiency of the radiological parameters and CT values.

Results: Framework destruction was a typical imaging feature in patients with FS (p < 0.001). In contrast, patients with BS were more prone to concave destruction (p = 0.002), corner destruction (p = 0.010) and severe marginal osteosclerosis (p < 0.001). The longitudinal erosion ratio (AUC = 0.948) and CT value (AUC = 0.789) exhibited excellent diagnostic utility.

Conclusions: The degree of bone destruction and severity of osteosclerosis significantly differed between the two types of spondylitis. Measuring the CT value and erosion ratio facilitates increased diagnostic accuracy and efficiency.