目的:本研究旨在根据实验室将结核性脊柱盘炎(TS)与化脓性脊柱盘炎(PS)区分开,磁共振成像(MRI)和计算机断层扫描(CT)的发现。Further,开发了一种新的鉴别诊断模型.
方法:我们获得了MRI,来自TS和PS患者的CT和实验室数据。使用二元逻辑回归分析建立预测模型。分析了接收机工作特性曲线。进行内部和外部验证。
结果:共纳入81例PS(n=46)或TS(n=35)患者。所有患者均有来自局灶性病变的病因证据。光盘信号或高度保护,跳过病变或多段(受累段≥3)受累,椎旁钙化,大量的死核形成,韧带下骨破坏,骨侵蚀与骨硬化边缘,较高的白细胞计数(WBC)和结核感染T细胞斑点试验(T-SPOT。TB)在TS组中更为普遍。建立了一个诊断模型,包括四个预测因子:白细胞<7.265*(10^9/L),跳过病变或受累节段≥3,大量死骨形成和韧带下骨破坏。模型显示出良好的灵敏度,特异性,和总精度(91.4%,95.7%,和93.8%,分别);接受者工作特征曲线下面积(AUC)为0.981,与使用Bootstrap重采样(1000次重复)和外部验证集的内部验证结果相似,表明良好的临床预测能力。
结论:本研究建立了基于CT和MRI的良好诊断模型,以及实验室发现,这可能有助于临床医生区分TS和PS。
OBJECTIVE: This study aimed to distinguish tuberculous spondylodiscitis (TS) from pyogenic spondylodiscitis (PS) based on laboratory, magnetic resonance imaging (MRI) and computed tomography (CT) findings. Further, a novel diagnostic model for differential diagnosis was developed.
METHODS: We obtained MRI, CT and laboratory data from TS and PS patients. Predictive models were built using binary logistic regression analysis. The receiver operating characteristic curve was analyzed. Both internal and external validation was performed.
RESULTS: A total of 81 patients with PS (n = 46) or TS (n = 35) were enrolled. All patients had etiological evidence from the focal lesion. Disc signal or height preservation, skip lesion or multi segment (involved segments ≥ 3) involvement, paravertebral calcification, massive sequestra formation, subligamentous bone destruction, bone erosion with osteosclerotic margin, higher White Blood Cell Count (WBC) and positive result of tuberculosis infection T cell spot test (T-SPOT.TB) were more prevalent in the TS group. A diagnostic model was developed and included four predictors: WBC<7.265 * (10^9/L), skip lesion or involved segments ≥ 3, massive sequestra formation and subligamentous bone destruction. The model showed good sensitivity, specificity, and total accuracy (91.4%, 95.7%, and 93.8%, respectively); the area under the receiver operating characteristic curve (AUC) was 0.981, similar to the results of internal validation using bootstrap resampling (1000 replicates) and external validation set, indicating good clinical predictive ability.
CONCLUSIONS: This study develop a good diagnostic model based on both CT and MRI, as well as laboratory findings, which may help clinicians distinguish between TS and PS.