Novel magnetic resonance imaging scoring system for diagnosis of spinal tuberculosis: A preliminary report

Yandrapati Bala Venkata Krishna Chandrasekhar; Alugolu Rajesh; Anirrudh Kumar Purohit; Yarralgadda Jyotsna Rani

doi:10.4103/0976-3147.112733

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Original Article

4 (

); 122-128

doi:

10.4103/0976-3147.112733

Novel magnetic resonance imaging scoring system for diagnosis of spinal tuberculosis: A preliminary report

Yandrapati Bala Venkata Krishna Chandrasekhar, Alugolu Rajesh, Anirrudh Kumar Purohit, Yarralgadda Jyotsna Rani¹

Departments of Neurosurgery, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, India

1Departments of Radiology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, India

Address for correspondence: Dr. Rajesh Alugolu Department of Neurosurgery, Nizam�s Institute of Medical Sciences Punjagutta, Hyderabad - 500 082 India drarajesh1306@gmail.com

Journal of Neurosciences in Rural Practice

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This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers Private Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

ABSTRACT

Background: There exists a lot of ambiguity in the preoperative diagnosis of the various vertebral lesions. Mostly in thesepatients tuberculosis of spine (TB) is suspected due to endemicity of the disease in the Indian subcontinent. However, nodefinite guidelines are available to diagnose tuberculous (TB) vertebral lesions in the current literature. Study Design: Thisprospective study was conducted in the Department of Neurosurgery, Nizam’s Institute of Medical Sciences, from August2009 to March 2012. Aim of the Study: To formulate non invasive methods to diagnose tuberculous vertebral lesionsconfidently so that the dependency on histopathologic diagnosis can be reduced. Material and Methods: Spinal MRIimages of 45 patients suspected of having tuberculosis aetiology were included in the study prospectively. Results: A totalof 64 patients were analysed and 19 patients were excluded due to lack of regular follow up or histological proof. The patientswere divided into two groups; those with TB of the spine and those with some other condition affecting the spine (nonTB spine) based on the final diagnosis. Of the 45 patients males were 30 (66.6%) and females were 15 (33.3%). There wasno significant difference in the mean age of presentation. For TB patients this was 41 ± 15.56 years and in Non TB was43 ± 18.27 years. All patients presented with backache in either group. There was epiphyseal involvement (100%), discheight reduction (71.42%) and pedicle destruction (42.82%) in plain X‑rays in the TB group. Lumbar spine was the mostcommon affected region in our study (26.31% in non TB and 34.6% in TB group of patients). Significant P value and the OddsRatio was found for T1 hypo intensity, T2 hyper intensity, epiphyseal involvement, disc involvement, pedicle involvement,anterior subligamentous extension, paraspinal extension and no spinous process involvement (eight parameters). Theeight parameters were tested among both the groups and it was noted that scores ≥ 6 favored a tuberculous pathologywhereas ≤4 were suggestive of non tuberculous etiology. Conclusions: The eight point MRI criteria of the vertebrallesions are likely to enhance the diagnostic ability of tuberculous and non tuberculous pathologies thereby reducing thedependency on histopathologic diagnosis or invasive method for early initiation of therapy.

Keywords

Diagnostic criteria

magnetic resonance imaging

scoring system

spinal tuberculosis

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Conflict of Interest

None declared

References

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Davidson P. T., Horowitz I, . Skeletal tuberculosis. AAm J Med. 1970;48:77-84.
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Oguz E, Sehirlioglu A, Altinmakas M, Ozturk C, Komurcu M, Solakoglu C, et al . A new classification and guide for surgical treatment of spinal tuberculosis. Int Orthop. 2008;32:127-33.
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Fanning A, . Tuberculosis: Extrapulmonary disease. CMAJ. 1999;160:1597-603.
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Boachie-Adjei O, Squillante R. G., . Tuberculosis of the spine. Orthop Clin North Am. 1996;27:95-103.
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Cagatay A. A., Caliskan Y, Aksoz S, Gulec L, Kucukoglu S, Cagatay Y, et al . Extrapulmonary tuberculosis in immunocompetent adults. Scand J Infect Dis. 2004;36:799-806.
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Jaffe H. L., . Metabolic, Degenerative and Inflammatory Diseases of Bone and Joints. Philadelphia: Lea and Febiger; 1972.
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Sharif H. S., . Role of MR imaging in the management of spinal infections. AJR Am J Roentgenol. 1992;158:1333-45.
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Sharif H. S., Morgan J. L., al Shahed M. S., al Thagafi M. Y., . Role of CT and MR imaging in the management of tuberculous spondylitis. Radiol Clin North Am. 1995;33:787-804.
[Google Scholar]
Sutton M. J., . Pyogenic osteomyelitis of the vertebral body. J Am Osteopath Assoc. 1984;83:724-8.
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Nas K, Kemaloglu M. S., Cevik R, Ceviz A, Necmioglu S, Bukte Y, et al . The results of rehabilitation on motor and functional improvement of the spinal tuberculosis. Joint Bone Spine. 2004;71:312-6.
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Colmenero J. D., Jimenez-Mejias M. E., Sanchez-Lora F. J., Reguera J. M., Palomino-Nicas J, Martos F, et al . Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: A descriptive and comparative study of 219 cases. Ann Rheum Dis. 1997;56:709-15.
[Google Scholar]
Lifeso R. M., Weaver P, Harder E. H., . Tuberculous spondylitis in adults. J Bone Joint Surg Am. 1985;67:1405-13.
[Google Scholar]
Wisneski R. J., . Infectious disease of the spine. Diagnostic and treatment considerations. Orthop Clin North Am. 1991;22:491-501.
[Google Scholar]
Perronne C, Saba J, Behloul Z, Salmon-Ceron D, Leport C, Vilde J. L., et al . Pyogenic and tuberculous spondylodiskitis (vertebral osteomyelitis) in 80 adult patients. Clin Infect Dis. 1994;19:746-50.
[Google Scholar]
Wasay M, Arif H, Khealani B, Ahsan H, . Neuroimaging of tuberculous myelitis: Analysis of ten cases and review of literature. J Neuroimaging. 2006;16:197-205.
[Google Scholar]
Moghtaderi A, Alavi-Naini R, Rahimi-Movaghar V, . Tuberculous myelopathy: Current aspects of neurologic sequels in the southeast of Iran. Acta Neurol Scand. 2006;113:267-72.
[Google Scholar]
Modic M. T., Feiglin D. H., Piraino D. W., Boumphrey F, Weinstein M. A., Duchesneau P. M., et al . Vertebral osteomyelitis: assessment using MR. Radiology. 1985;157:157-66.
[Google Scholar]
Cottle L, Riordan T, . Infectious spondylodiscitis. J Infect. 2008;56:401-12.
[Google Scholar]
Jung N. Y., Jee W. H., Ha K. Y., Park C. K., Byun J. Y., . Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. AJR Am J Roentgenol. 2004;182:1405-10.
[Google Scholar]
Meyers S. P., Wiener S. N., . Diagnosis of hematogenous pyogenic vertebral osteomyelitis by magnetic resonance imaging. Arch Intern Med. 1991;151:683-7.
[Google Scholar]
Yoshikawa T, Maeda M, Ueda Y, Matsuyama E, Kugai A, Tamai S, et al . Magnetic resonance imaging in the early phase of pyogenic spondylitis: A report of four cases. J Orthop Sci. 1997;2:16-23.
[Google Scholar]
McLain R. F., Isada C, . Spinal tuberculosis deserves a place on the radar screen. Cleve Clin J Med. 2004;71:537-9.
[Google Scholar]
Quinones-Hinojosa A, Jun P, Jacobs R, Rosenberg W. S., Weinstein P. R., . General principles in the medical and surgical management of spinal infections: A multidisciplinary approach. Neurosurg Focus. 2004;17:E1.
[Google Scholar]
Hoffman E. B., Crosier J. H., Cremin B. J., . Imaging in children with spinal tuberculosis. A comparison of radiography, computed tomography and magnetic resonance imaging. J Bone Joint Surg Br. 1993;75:233-9.
[Google Scholar]
Teo E. L., Peh W. C., . Imaging of tuberculosis of the spine. Singapore Med J. 2004;45:439-44.
[Google Scholar]
Modic M. T., Feiglin D. H., Piraino D. W., Boumphrey F, Weinstein M. A., Duchesneau P. M., et al . Vertebral osteomyelitis: assessment using MR. Radiology. 1985;157:157-66.
[Google Scholar]
Griffiths H. E., Jones D. M., . Pyogenic infection of the spine. A review of twenty-eight cases. J Bone Joint Surg Br. 1971;53:383-91.
[Google Scholar]
Forrester D. M., . Infectious spondylitis. Semin Ultrasound CT MR. 2004;25:461-73.
[Google Scholar]
Garcia A Jr, Grantham S. A., . Hematogenous pyogenic vertebral osteomyelitis. J Bone Joint Surg Am. 1960;42:429-36.
[Google Scholar]
Govender S, . Spinal infections. J Bone Joint Surg Br. 2005;87:1454-8.
[Google Scholar]
Grados F, Lescure F. X., Senneville E, Flipo R. M., Schmit J. L., Fardellone P, . Suggestions for managing pyogenic discitis in adults. Joint Bone Spine. 2007;74:133-9.
[Google Scholar]
Shanley D. J., . Tuberculosis of the spine: Imaging features. AJR Am J Roentgenol. 1995;164:659-64.
[Google Scholar]
Moorthy S, Prabhu N. K., . Spectrum of MR imaging findings in spinal tuberculosis. AJR Am J Roentgenol. 2002;179:979-83.
[Google Scholar]
Cormican L, Hammal R, Messenger J, Milburn H. J., . Current difficulties in the diagnosis and management of spinal tuberculosis. Postgrad Med J. 2006;82:46-51.
[Google Scholar]
Rahme R, Moussa R, . The modic vertebral endplate and marrow changes: Pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol. 2008;29:838-42.
[Google Scholar]
Modic M. T., Steinberg P. M., Ross J. S., Masaryk T. J., Carter J. R., . Degenerative disk disease: Assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166:193-9.
[Google Scholar]
Modic M. T., Masaryk T. J., Ross J. S., Carter J. R., . Imaging of degenerative disk disease. Radiology. 1988;168:177-86.
[Google Scholar]
Nussbaum E. S., Rockswold G. L., Bergman T. A., Erickson D. L., Seljeskog E. L., . Spinal tuberculosis: a diagnostic and management challenge. J Neurosurg. 1995;83:243-7.
[Google Scholar]
Rezai A. R., Lee M, Cooper P. R., Errico T. J., Koslow M, . Modern management of spinal tuberculosis. Neurosurgery. 1995;36:87-97.
[Google Scholar]
Horsburgh C. R. Jr, Feldman S, Ridzon R, . Infectious Diseases Society of A. Practice guidelines for the treatment of tuberculosis. Clin Infect Dis. 2000;31:633-9.
[Google Scholar]
Armstrong P, Chalmers A. H., Green G, Irving J. D., . Needle aspiration/biopsy of the spine in suspected disc infection. Br J Radiol. 1978;51:333-7.
[Google Scholar]
Sapico F. L., Montgomerie J. Z., . Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Rev Infect Dis. 1979;1:754-76.
[Google Scholar]
Resnick D, Niwayama G, . Osteomyelitis, septic arthritis and soft tissue infection: the axial skeleton.Diagnosis of Bone and Joint Disorders. Philadelphia: Saunders; 1988. p. :2619-754. In: editors
[Google Scholar]
Sharif H. S., Aideyan O. A., Clark D. C., Madkour M. M., Aabed M. Y., Mattsson T. A., et al . Brucellar and tuberculous spondylitis: Comparative imaging features. Radiology. 1989;171:419-25.
[Google Scholar]
Weaver P, Lifeso R. M., . The radiological diagnosis of tuberculosis of the adult spine. Skeletal Radiol. 1984;12:178-86.
[Google Scholar]

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[1] Fitzgerald D, Haas D. W., . Mycobacterium tuberculosis.Principles and Practice of Infectious Diseases. (6 th ed). Philadelphia: Elsevier Churchill Livingstone; 2005. p. :2852-85. In: editors
[Google Scholar]

[2] Davidson P. T., Horowitz I, . Skeletal tuberculosis. AAm J Med. 1970;48:77-84.
[Google Scholar]

[3] Mehta J. S., Bhojraj S. Y., . Tuberculosis of the thoracic spine. AJ Bone Joint Surg Br. 2001;83:859-63.
[Google Scholar]

[4] Oguz E, Sehirlioglu A, Altinmakas M, Ozturk C, Komurcu M, Solakoglu C, et al . A new classification and guide for surgical treatment of spinal tuberculosis. Int Orthop. 2008;32:127-33.
[Google Scholar]

[5] al-Mulhim F. A., Ibrahim E. M., el-Hassan A. Y., Moharram H. M., . Magnetic resonance imaging of tuberculous spondylitis. Spine. 1995;20:2287-92.
[Google Scholar]

[6] Fanning A, . Tuberculosis: Extrapulmonary disease. CMAJ. 1999;160:1597-603.
[Google Scholar]

[7] Pertuiset E, Beaudreuil J, Liote F, Horusitzky A, Kemiche F, Richette P, et al . Spinal tuberculosis in adults. AMedicine. 1999;78:309-20.
[Google Scholar]

[8] Moon M. S., . Tuberculosis of the spine. Controversies and a new challenge. Spine. 1997;22:1791-7.
[Google Scholar]

[9] Boachie-Adjei O, Squillante R. G., . Tuberculosis of the spine. Orthop Clin North Am. 1996;27:95-103.
[Google Scholar]

[10] Miller J. D., . Pott’s paraplegia today. Lancet. 1995;346:264.
[Google Scholar]

[11] Gautam M. P., Karki P, Rijal S, Singh R, . Pott’s spine and paraplegia. JNMA J Nepal Med Assoc. 2005;44:106-15.
[Google Scholar]

[12] Sinan T, Al-Khawari H, Ismail M, Ben-Nakhi A, Sheikh M, . Spinal tuberculosis: CT and MRI feature. Ann Saudi Med. 2004;24:437-41.
[Google Scholar]

[13] Jutte P. C., Van Loenhout-Rooyackers J. H., . Routine surgery in addition to chemotherapy for treating spinal tuberculosis. Cochrane Database Syst Rev. 2006;1:CD004532.
[Google Scholar]

[14] A 15-year assessment of controlled trials of the management of tuberculosis of the spine in Korea and Hong Kong. Thirteenth Report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg. 1998;80:456-62.
[Google Scholar]

[15] Chan E. D., Iseman M. D., . Current medical treatment for tuberculosis. BMJ. 2002;325:1282-6.
[Google Scholar]

[16] Ansari S, Ashraf A. N., Al Moutaery K, . Spinal infections: A review. Neurosurgery Q. 2001;11:112-23.
[Google Scholar]

[17] Gupta R, Espinal M. A., Raviglione M. C., . Tuberculosis as a major global health problem in the 21 st Century: A WHO perspective. Semin Respir Crit Care Med. 2004;25:245-53.
[Google Scholar]

[18] Iseman M. D., . A Clinician’s Guide to Tuberculosis. Philadelphia: Lippincott, Williams and Wilkins; 2000.
[Google Scholar]

[19] Cagatay A. A., Caliskan Y, Aksoz S, Gulec L, Kucukoglu S, Cagatay Y, et al . Extrapulmonary tuberculosis in immunocompetent adults. Scand J Infect Dis. 2004;36:799-806.
[Google Scholar]

[20] Alothman A, Memish Z. A., Awada A, Al-Mahmood S, Al-Sadoon S, Rahman M. M., et al . Tuberculous spondylitis: Analysis of 69 cases from Saudi Arabia. Spine. 2001;26:E565-70.
[Google Scholar]

[21] Khorvash F, Javadi A. A., Izadi M, Jonaidi Jafari N, Ranjbar R, . Spinal tuberculosis: A major public health hazard in Isfahan. Pak J Biol Sci. 2007;10:3400-4.
[Google Scholar]

[22] Jaffe H. L., . Metabolic, Degenerative and Inflammatory Diseases of Bone and Joints. Philadelphia: Lea and Febiger; 1972.
[Google Scholar]

[23] Sharif H. S., . Role of MR imaging in the management of spinal infections. AJR Am J Roentgenol. 1992;158:1333-45.
[Google Scholar]

[24] Sharif H. S., Morgan J. L., al Shahed M. S., al Thagafi M. Y., . Role of CT and MR imaging in the management of tuberculous spondylitis. Radiol Clin North Am. 1995;33:787-804.
[Google Scholar]

[25] Sutton M. J., . Pyogenic osteomyelitis of the vertebral body. J Am Osteopath Assoc. 1984;83:724-8.
[Google Scholar]

[26] Nas K, Kemaloglu M. S., Cevik R, Ceviz A, Necmioglu S, Bukte Y, et al . The results of rehabilitation on motor and functional improvement of the spinal tuberculosis. Joint Bone Spine. 2004;71:312-6.
[Google Scholar]

[27] Colmenero J. D., Jimenez-Mejias M. E., Sanchez-Lora F. J., Reguera J. M., Palomino-Nicas J, Martos F, et al . Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: A descriptive and comparative study of 219 cases. Ann Rheum Dis. 1997;56:709-15.
[Google Scholar]

[28] Lifeso R. M., Weaver P, Harder E. H., . Tuberculous spondylitis in adults. J Bone Joint Surg Am. 1985;67:1405-13.
[Google Scholar]

[29] Wisneski R. J., . Infectious disease of the spine. Diagnostic and treatment considerations. Orthop Clin North Am. 1991;22:491-501.
[Google Scholar]

[30] Perronne C, Saba J, Behloul Z, Salmon-Ceron D, Leport C, Vilde J. L., et al . Pyogenic and tuberculous spondylodiskitis (vertebral osteomyelitis) in 80 adult patients. Clin Infect Dis. 1994;19:746-50.
[Google Scholar]

[31] Wasay M, Arif H, Khealani B, Ahsan H, . Neuroimaging of tuberculous myelitis: Analysis of ten cases and review of literature. J Neuroimaging. 2006;16:197-205.
[Google Scholar]

[32] Moghtaderi A, Alavi-Naini R, Rahimi-Movaghar V, . Tuberculous myelopathy: Current aspects of neurologic sequels in the southeast of Iran. Acta Neurol Scand. 2006;113:267-72.
[Google Scholar]

[33] Modic M. T., Feiglin D. H., Piraino D. W., Boumphrey F, Weinstein M. A., Duchesneau P. M., et al . Vertebral osteomyelitis: assessment using MR. Radiology. 1985;157:157-66.
[Google Scholar]

[34] Cottle L, Riordan T, . Infectious spondylodiscitis. J Infect. 2008;56:401-12.
[Google Scholar]

[35] Jung N. Y., Jee W. H., Ha K. Y., Park C. K., Byun J. Y., . Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. AJR Am J Roentgenol. 2004;182:1405-10.
[Google Scholar]

[36] Meyers S. P., Wiener S. N., . Diagnosis of hematogenous pyogenic vertebral osteomyelitis by magnetic resonance imaging. Arch Intern Med. 1991;151:683-7.
[Google Scholar]

[37] Yoshikawa T, Maeda M, Ueda Y, Matsuyama E, Kugai A, Tamai S, et al . Magnetic resonance imaging in the early phase of pyogenic spondylitis: A report of four cases. J Orthop Sci. 1997;2:16-23.
[Google Scholar]

[38] McLain R. F., Isada C, . Spinal tuberculosis deserves a place on the radar screen. Cleve Clin J Med. 2004;71:537-9.
[Google Scholar]

[39] Quinones-Hinojosa A, Jun P, Jacobs R, Rosenberg W. S., Weinstein P. R., . General principles in the medical and surgical management of spinal infections: A multidisciplinary approach. Neurosurg Focus. 2004;17:E1.
[Google Scholar]

[40] Hoffman E. B., Crosier J. H., Cremin B. J., . Imaging in children with spinal tuberculosis. A comparison of radiography, computed tomography and magnetic resonance imaging. J Bone Joint Surg Br. 1993;75:233-9.
[Google Scholar]

[41] Teo E. L., Peh W. C., . Imaging of tuberculosis of the spine. Singapore Med J. 2004;45:439-44.
[Google Scholar]

[42] Modic M. T., Feiglin D. H., Piraino D. W., Boumphrey F, Weinstein M. A., Duchesneau P. M., et al . Vertebral osteomyelitis: assessment using MR. Radiology. 1985;157:157-66.
[Google Scholar]

[43] Griffiths H. E., Jones D. M., . Pyogenic infection of the spine. A review of twenty-eight cases. J Bone Joint Surg Br. 1971;53:383-91.
[Google Scholar]

[44] Forrester D. M., . Infectious spondylitis. Semin Ultrasound CT MR. 2004;25:461-73.
[Google Scholar]

[45] Garcia A Jr, Grantham S. A., . Hematogenous pyogenic vertebral osteomyelitis. J Bone Joint Surg Am. 1960;42:429-36.
[Google Scholar]

[46] Govender S, . Spinal infections. J Bone Joint Surg Br. 2005;87:1454-8.
[Google Scholar]

[47] Grados F, Lescure F. X., Senneville E, Flipo R. M., Schmit J. L., Fardellone P, . Suggestions for managing pyogenic discitis in adults. Joint Bone Spine. 2007;74:133-9.
[Google Scholar]

[48] Shanley D. J., . Tuberculosis of the spine: Imaging features. AJR Am J Roentgenol. 1995;164:659-64.
[Google Scholar]

[49] Moorthy S, Prabhu N. K., . Spectrum of MR imaging findings in spinal tuberculosis. AJR Am J Roentgenol. 2002;179:979-83.
[Google Scholar]

[50] Cormican L, Hammal R, Messenger J, Milburn H. J., . Current difficulties in the diagnosis and management of spinal tuberculosis. Postgrad Med J. 2006;82:46-51.
[Google Scholar]

[51] Rahme R, Moussa R, . The modic vertebral endplate and marrow changes: Pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol. 2008;29:838-42.
[Google Scholar]

[52] Modic M. T., Steinberg P. M., Ross J. S., Masaryk T. J., Carter J. R., . Degenerative disk disease: Assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166:193-9.
[Google Scholar]

[53] Modic M. T., Masaryk T. J., Ross J. S., Carter J. R., . Imaging of degenerative disk disease. Radiology. 1988;168:177-86.
[Google Scholar]

[54] Nussbaum E. S., Rockswold G. L., Bergman T. A., Erickson D. L., Seljeskog E. L., . Spinal tuberculosis: a diagnostic and management challenge. J Neurosurg. 1995;83:243-7.
[Google Scholar]

[55] Rezai A. R., Lee M, Cooper P. R., Errico T. J., Koslow M, . Modern management of spinal tuberculosis. Neurosurgery. 1995;36:87-97.
[Google Scholar]

[56] Horsburgh C. R. Jr, Feldman S, Ridzon R, . Infectious Diseases Society of A. Practice guidelines for the treatment of tuberculosis. Clin Infect Dis. 2000;31:633-9.
[Google Scholar]

[57] Armstrong P, Chalmers A. H., Green G, Irving J. D., . Needle aspiration/biopsy of the spine in suspected disc infection. Br J Radiol. 1978;51:333-7.
[Google Scholar]

[58] Sapico F. L., Montgomerie J. Z., . Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Rev Infect Dis. 1979;1:754-76.
[Google Scholar]

[59] Resnick D, Niwayama G, . Osteomyelitis, septic arthritis and soft tissue infection: the axial skeleton.Diagnosis of Bone and Joint Disorders. Philadelphia: Saunders; 1988. p. :2619-754. In: editors
[Google Scholar]

[60] Sharif H. S., Aideyan O. A., Clark D. C., Madkour M. M., Aabed M. Y., Mattsson T. A., et al . Brucellar and tuberculous spondylitis: Comparative imaging features. Radiology. 1989;171:419-25.
[Google Scholar]

[61] Weaver P, Lifeso R. M., . The radiological diagnosis of tuberculosis of the adult spine. Skeletal Radiol. 1984;12:178-86.
[Google Scholar]

Novel magnetic resonance imaging scoring system for diagnosis of spinal tuberculosis: A preliminary report

Abstract

ABSTRACT

Keywords

Diagnostic criteria

magnetic resonance imaging

scoring system

spinal tuberculosis

Conflict of Interest

References

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