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Yasin P, Yimit Y, Abliz D, Mardan M, Xu T, Yusufu A, Cai X, Sheng W, Mamat M. MRI-based interpretable radiomics nomogram for discrimination between Brucella spondylitis and Pyogenic spondylitis. Heliyon 2024; 10:e23584. [PMID: 38173524 PMCID: PMC10761805 DOI: 10.1016/j.heliyon.2023.e23584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
Background Pyogenic spondylitis (PS) and Brucella spondylitis (BS) are commonly seen spinal infectious diseases. Both types can lead to vertebral destruction, kyphosis, and long-term neurological deficits if not promptly diagnosed and treated. Therefore, accurately diagnosis is crucial for personalized therapy. Distinguishing between PS and BS in everyday clinical settings is challenging due to the similarity of their clinical symptoms and imaging features. Hence, this study aims to evaluate the effectiveness of a radiomics nomogram using magnetic resonance imaging (MRI) to accurately differentiate between the two types of spondylitis. Methods Clinical and MRI data from 133 patients (2017-2022) with pathologically confirmed PS and BS (68 and 65 patients, respectively) were collected. We have divided patients into training and testing cohorts. In order to develop a clinical diagnostic model, logistic regression was utilized to fit a conventional clinical model (M1). Radiomics features were extracted from sagittal fat-suppressed T2-weighted imaging (FS-T2WI) sequence. The radiomics features were preprocessed, including scaling using Z-score and undergoing univariate analysis to eliminate redundant features. Furthermore, the Least Absolute Shrinkage and Selection Operator (LASSO) was employed to develop a radiomics score (M2). A composite model (M3) was created by combining M1 and M2. Subsequently, calibration and decision curves were generated to evaluate the nomogram's performance in both training and testing groups. The diagnostic performance of each model and the indication was assessed using the receiver operating curve (ROC) with its area under the curve (AUC). Finally, we used the SHapley Additive exPlanations (SHAP) model explanations technique to interpret the model result. Results We have finally selected 9 significant features from sagittal FS-T2WI sequences. In the differential diagnosis of PS and BS, the AUC values of M1, M2, and M3 in the testing set were 0.795, 0.859, and 0.868. The composite model exhibited a high degree of concurrence with the ideal outcomes, as evidenced by the calibration curves. The nomogram's possible clinical application values were indicated by the decision curve analysis. By using SHAP values to represent prediction outcomes, our model's prediction results are more understandable. Conclusions The implementation of a nomogram that integrates MRI and clinical data has the potential to significantly enhance the accuracy of discriminating between PS and BS within clinical settings.
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Affiliation(s)
- Parhat Yasin
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Yasen Yimit
- Department of Radiology, The First People’s Hospital of Kashi Prefecture, Kashi, Xinjiang, 844000, China
| | - Dilxat Abliz
- Department of Orthopedic, The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Muradil Mardan
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Department of Spine Center, Shanghai, 200092, China
| | - Tao Xu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Aierpati Yusufu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Xiaoyu Cai
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Mardan Mamat
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
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Li Y, Fei L, Shi J. Efficacy of posterior fixation and bone graft fusion for treatment of lumbar brucellosis spondylitis. Medicine (Baltimore) 2023; 102:e36577. [PMID: 38115351 PMCID: PMC10727668 DOI: 10.1097/md.0000000000036577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
The purpose of this study is to verify whether early stage patients with single-segment lumbar Brucella spondylitis can still be cured through simple posterior fixation and bone grafting, even without debridement. A retrospective study was conducted on 63 patients diagnosed with single-segment lumbar brucellosis spondylitis, who underwent posterior-only debridement (or not), bone grafting, and instrumentation from June 2016 to June 2019. Group A comprised 34 patients who did not undergo debridement, while group B comprised 29 patients who underwent debridement. The clinical data and imaging results of the patients were compared between the 2 groups to evaluate the clinical effects of debridement or not. Both groups of patients completed at least 1 year of follow-up. The group A had significantly lower values for operation time, blood loss, and hospital stay compared to the group B (P < .05). There were no significant differences between the 2 groups in terms of erythrocyte sedimentation rate, C-reactive protein, visual analogue scores, improvement of Japanese Orthopaedic Association Evaluation of treatment score, and Cobb angle. The bone fusion rate was 92% (31 patients) in group A and 96% (28 patients) in group B, with no significant difference between the 2 groups (P > .05). In summary, these findings suggest that posterior fixation and bone graft fusion are effective treatments for single-segment lumbar brucellosis spondylitis in early stages even without debridement. Importantly, these procedures offer several benefits, such as minimal trauma, short operation times, rapid postoperative recovery, and favorable bone graft fusion outcomes.
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Affiliation(s)
- Yu Li
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Le Fei
- Ningxia Medical University, Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jiandang Shi
- Ningxia Medical University, Department of Spine Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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Meer E, Patel M, Chan D, Sheikh AM, Nicolaou S. Dual-Energy Computed Tomography and Beyond: Musculoskeletal System. Radiol Clin North Am 2023; 61:1097-1110. [PMID: 37758359 DOI: 10.1016/j.rcl.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Traditional monoenergetic computed tomography (CT) scans in musculoskeletal imaging provide excellent detail of bones but are limited in the evaluation of soft tissues. Dual-energy CT (DECT) overcomes many of the traditional limitations of CT and offers anatomical details previously seen only on MR imaging. In addition, DECT has benefits in the evaluation and characterization of arthropathies, bone marrow edema, and collagen applications in the evaluation of tendons, ligaments, and vertebral discs. There is current ongoing research in the application of DECT in arthrography and bone mineral density calculation.
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Affiliation(s)
- Emtenen Meer
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada; King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
| | - Mitulkumar Patel
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Chan
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Adnan M Sheikh
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Vancouver General Hospital-University of British Columbia, Vancouver, British Columbia, Canada
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Abdominal Lymphadenopathies: Lymphoma, Brucellosis or Tuberculosis? Multidisciplinary Approach-Case Report and Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020293. [PMID: 36837494 PMCID: PMC9964815 DOI: 10.3390/medicina59020293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
Abdominal pain represents a frequent symptom for referral to emergency departments and/or internal medicine outpatient setting. Similarly, fever, fatigue and weight loss are non-specific manifestations of disease. The present case describes the diagnostic process in a patient with abdominal pain and a palpable abdominal mass. Abdominal ultrasonography confirmed the presence of a mass in the mesogastrium. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans oriented toward calcific lymphadenopathies with increased metabolism in the positron emission tomography-computed tomography (PET-CT) scan. Laboratory examinations were inconclusive, although serology for Brucella and the Quantiferon test were positive. After multidisciplinary discussion, the patient underwent surgical excision of the abdominal mass. Histological examination excluded malignancies and oriented toward brucellosis in a patient with latent tuberculosis. The patient was treated with rifampin 600 mg qd and doxycycline 100 mg bid for 6 weeks with resolution of the symptoms. In addition, rifampin was continued for a total of 6 months in order to treat latent tuberculosis. This case underlines the need for a multidisciplinary approach in the diagnostic approach to abdominal lymphadenopathies.
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Ma H, Zhang N, Liu J, Wang X, Yang Z, Lou C, Ji J, Zhai X, Niu N. Pathological features of Brucella spondylitis: A single-center study. Ann Diagn Pathol 2022; 58:151910. [DOI: 10.1016/j.anndiagpath.2022.151910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/30/2022] [Indexed: 11/16/2022]
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Liu H, Wang X, Wang W, Sun Y, Guo L, Zhang F, Li J, Zhang P, Zhang W. WITHDRAWN: Spinal epidural abscess with emphasis on early diagnosis and surgical treatment: Report of twenty-five cases and review of literature. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Heyde CE, Lübbert C, Wendt S, Rodloff A, Völker A, von NHDH. Spinal Tuberculosis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 160:74-83. [PMID: 33477180 DOI: 10.1055/a-1285-4994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Tuberculosis is one of the most common infectious diseases worldwide. The frequency in Germany is low, however, an increase has been observed in the past few years. The incidence of extrapulmonary manifestation accounts for up to 10 to 20%. In 50% of these cases the spinal column is affected. Although literature reveals worldwide experiences in the treatment, in Germany spinal tuberculosis remains a rarity. Different pitfalls and specific characteristics regarding diagnosis and therapy are to consider. Therefore, a presentation of these specifics and their discussion based on the available literature will be presented. The purpose is to achieve an increase in awareness regarding this, in our latitudes, rare disease.
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Affiliation(s)
- Christoph Eckhard Heyde
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Christoph Lübbert
- Department of Oncology, Gastroenterology, Hepatology, Respiratory Medicine, Infectiology, Infectious Disease and Tropical Medicine Section, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Sebastian Wendt
- Department of Oncology, Gastroenterology, Hepatology, Respiratory Medicine, Infectiology, Infectious Disease and Tropical Medicine Section, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Arne Rodloff
- Institute of Medical Microbiology and Infection Epidemiology, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Anna Völker
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Nicolas H der Höh von
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Leipzig, Germany
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Kamal AM, El-Sharkawi MM, El-Sabrout M, Hassan MG. Spondylodiscitis: experience of surgical management of complicated cases after failed antibiotic treatment. SICOT J 2020; 6:5. [PMID: 32057290 PMCID: PMC7020778 DOI: 10.1051/sicotj/2020002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/28/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The term Spondylodiscitis (SD) involves infection of the vertebra (Spondylitis), infection of the intervertebral disc (Discitis), or both (Spondylodiscitis). SD represents a diagnostic and therapeutic challenge to any spine surgeon. Any delay in its diagnosis or management may cause serious long-term morbidity or even lead to mortality. In this study, we report the experience of our Institution in the management of severe and complicated cases of SD. METHODS Over a period of 1 year, 39 patients with the diagnosis of SD were surgically treated in Assiut University Hospital, Assiut, Egypt. The management processes were tailored according to the clinical condition, radiological and lab studies of each case; and patients were then prospectively followed-up until they were cured (for a minimum of 6 months). The outcomes were analyzed, to be able to give recommendations while aiming to improve the overall outcome of such dangerous health issue. RESULTS In this series, patients were managed surgically by drainage and debridement of the infection site with/without instrumented fusion. Results included: satisfactory fusion was achieved in 97.3% of patients (confidence interval [CI] = 0.6856-1.3421). Neurological Improvement Rate (NIR) was 71.5% (Statistically significant improvement P-value = 0.014) and reoperation rate was 5% (CI = 0.00621-0.18525). Mortality rate was 7.7% (CI = 0.016-0.209). Several aspects were analyzed in each case. CONCLUSION Surgical management of severe and complicated cases of SD allows for effective debridement and rapid cure of inflammation, earlier patient mobilization and significantly shorter duration of antibiotic usage.
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Affiliation(s)
- Abdullah Mohammed Kamal
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut 71511, Egypt
| | - Mohammad M El-Sharkawi
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut 71511, Egypt
| | - Moataz El-Sabrout
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut 71511, Egypt
| | - Mohammad Gamal Hassan
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut 71511, Egypt
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Establishment and Initial Testing of a Medium-Sized, Surgically Feasible Animal Model for Brucellar Spondylodiscitis: A Preliminary Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7368627. [PMID: 31662995 PMCID: PMC6791230 DOI: 10.1155/2019/7368627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/04/2019] [Accepted: 08/30/2019] [Indexed: 02/06/2023]
Abstract
Brucellar spondylodiscitis, the most prevalent and significant osteoarticular presentation of human Brucellosis, is difficult to diagnose and usually yields irreversible neurologic deficits and spinal deformities. However, no animal models of Brucellar spondylodiscitis exist, allowing for preclinical investigations. The present study investigated whether intraosseous injection of attenuated Brucella melitensis vaccine into rabbits' lumbar vertebrae imitates the radiographic and histopathological characteristics of human Brucellar spondylodiscitis. Radiographic and histopathological analyses at 8 weeks postoperatively revealed radiographic changes within vertebral bodies and intervertebral discs, abscesses formation within the paravertebral soft tissue, and typical prominent inflammation response without caseous necrosis, which were largely comparable to human Brucellar spondylodiscitis. Such a medium-sized, surgically feasible rabbit model provides a promising in vivo setting for further preclinical investigation of Brucellar spondylodiscitis.
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Could Hyperbaric Oxygen Be a Solution in the Treatment of Spinal Infections? ACTA ACUST UNITED AC 2019; 55:medicina55050164. [PMID: 31137457 PMCID: PMC6571771 DOI: 10.3390/medicina55050164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/02/2019] [Accepted: 05/16/2019] [Indexed: 12/20/2022]
Abstract
Background and Objective: Pyogenic spinal infections are rare and potentially devastating, requiring prompt recognition and management. Parallel to the ever-increasing number of invasive spinal procedures, its incidence is on a steady rise, particularly in an expanding elderly population. The aim of this study was to evaluate the efficacy of hyperbaric oxygen (HBO2) therapy in the treatment of this heterogeneous group of disorders. Materials and Methods: Nineteen patients who were referred to our center for HBO2 with a clinical diagnosis of spinal infections (vertebral osteomyelitis, pyogenic spondylitis, spondylodiscitis, surgical site infection following spine surgery, epidural abscess) were retrospectively reviewed. Results: Infection resolution was adequately achieved in 12 of 13 patients (92.3%) on magnetic resonance imaging at the end of HBO2 treatment or during the first month of follow-up. The mean follow-up period was 11 months (range 1 month to 3 years). Conclusions: This study suggests that HBO2 therapy is efficacious in patients with pyogenic spinal infections complicated by primary therapy failure or by medical comorbidities that may impede the eradication of microbial infection and delay wound healing. HBO2 therapy may be useful for reducing long hospital stays, repeated surgeries, and morbidities.
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Li T, Li W, Du Y, Gao M, Liu X, Wang G, Cui H, Jiang Z, Cui X, Sun J. Discrimination of pyogenic spondylitis from brucellar spondylitis on MRI. Medicine (Baltimore) 2018; 97:e11195. [PMID: 29952971 PMCID: PMC6039692 DOI: 10.1097/md.0000000000011195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Retrospective Cross-Sectional Study.The purpose of this study was to investigate the accuracy of magnetic resonance imaging (MRI) for distinguishing between pyogenic spondylitis and brucellar spondylitis.Although pyogenic spondylodiscitis (PS) and brucellar spondylitis (BS) are common causes of spinal infections, the variety of their clinical manifestations complicates differential diagnosis. MRI may be helpful in differential diagnosis and treatment.MRI images of 64 patients who underwent MRI of the spine and with confirmed spondylitis were retrospectively reviewed. After referring to the related medical literature, we compared 32 patients with pyogenic spondylitis and 32 patients with brucellar spondylitis regarding MRI findings. Statistical analysis was performed with the chi-square test. Statistical significance was defined as P < .05.The significant differences between PS and BS on MRI findings are listed as follows (P < .05): diffuse, partial and fan-shaped hyperintense signals on middle sagittal fat-suppressed weighted images (PS: 51, 11, 3/65 vs BS:35, 18, 19/72); focal endplate destruction (PS: 9/43 vs BS:27/35); extensive end plate destruction (PS: 29/43 vs BS:8/35); ballooning change of the intravertebral space (PS: 7/32 vs BS:0/32); an inflammatory reaction line from the end plate (PS: 30/65 vs BS: 1/72); a disc invasion sign (PS: 1/28 vs BS:12/33); an inflammatory reaction line in the disc (PS: 5/28 vs BS:25/33); and 8) severe intravertebral space destruction (PS: 17/28 vs BS:12/33);MRI imaging provides useful information for the differentiation between pyogenic spondylitis and brucellar spondylitis.
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Affiliation(s)
- Tao Li
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Wei Li
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Yong Du
- Department of Orthopedics, Qingyun County People's Hospital, Jinan City, PR China
| | - Meng Gao
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Xiaoyang Liu
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Guodong Wang
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Haomin Cui
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Zhensong Jiang
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Xingang Cui
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Jianmin Sun
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
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