目的:本研究旨在比较和分析结核性脊椎盘炎(TbS)和化脓性脊椎盘炎(PyS)的临床和磁共振成像(MRI)表现的差异,并开发和验证一种简化的基于多参数MRI的评分系统,以区分TbS和PyS。
方法:我们比较了190例患者的诱发因素:123例TbS和67例PyS,通过实验室测试证实,文化,或病理学。包含患者人口统计信息的数据,临床特征,实验室结果,收集了2015年至2020年之间的MRI检查结果。采用logistic回归方法对数据进行分析,并将选定的系数转换为基于MRI的评分系统。使用自举方法执行内部验证。
结果:单因素分析显示,与TbS相关的重要危险因素包括胸部病变,椎体破坏>50%,骨内脓肿,薄壁脓肿,明确定义的椎旁脓肿,韧带下蔓延,和硬膜外脓肿。多因素分析显示,只有胸部病变,没有硬膜外痰,韧带下蔓延,骨内脓肿,明确定义的椎旁脓肿,硬膜外脓肿,和小关节关节炎的缺失是TbS的独立预测因素(均p<0.05)。这些潜在的预测因子用于推导MRI评分系统。总分≥14/29分显着预测TbS的概率,灵敏度为97.58%,特异性92.54%,曲线下面积为0.96(95%置信区间,125.40-3,257.95)。
结论:这种用于区分TbS和PyS的简化的基于MRI的评分系统有助于在未确定病原体时指导适当的治疗。
OBJECTIVE: This study aimed to compare and analyze differences in clinical and magnetic resonance imaging (MRI) findings between tuberculous spondylodiscitis (TbS) and pyogenic spondylodiscitis (PyS), and to develop and validate a simplified multiparameter MRIbased scoring system for differentiating TbS from PyS.
METHODS: We compared predisposing factors in 190 patients: 123 with TbS and 67 with PyS, confirmed by laboratory tests, culture, or pathology. Data encompassing patient demographics, clinical characteristics, laboratory results, and MRI findings were collected between 2015 and 2020. Data were analyzed using logistic regression methods, and selected coefficients were transformed into an MRI-based scoring system. Internal validation was performed using bootstrapping method.
RESULTS: Univariate analysis revealed that the significant risk factors associated with TbS included thoracic lesions, vertebral destruction > 50%, intraosseous abscess, thin-walled abscess, well-defined paravertebral abscess, subligamentous spreading, and epidural abscess. Multivariate analysis revealed that only thoracic lesions, absence of epidural phlegmon, subligamentous spreading, intraosseous abscesses, well-defined paravertebral abscesses, epidural abscesses, and absence of facet joint arthritis were independent predictive factors for TbS (all p < 0.05). These potential predictors were used to derive an MRI scoring system. Total scores ≥ 14/29 points significantly predicted the probability of TbS, with a sensitivity of 97.58%, specificity of 92.54%, and an area under the curve of 0.96 (95% confidence interval, 125.40-3,257.95).
CONCLUSIONS: This simplified MRI-based scoring system for differentiating TbS from PyS helps guide appropriate treatment when the causative organism is not identified.