Capabilities of combined application of multislice linear digital X-ray tomography and ultrasound examination in diagnosing spinal tuberculous lesion

Abstract

The aim of the investigation was to assess the capabilities of combined application of multislice linear digital X-ray tomography (tomosynthesis) and ultrasound examination in diagnosing spinal tuberculous lesion. Materials and methods. 117 patients with tuberculous spondylitis (n=46) and hematogenous vertebral osteomyelitis (n=71), treated from 2010 to 2015 in the Research Institute of Phthisiopulmonology affiliated to I.M. Sechenov First Moscow State Medical University, were included into the study. Results. The main radiation signs of tuberculous spondylitis and hematogenous vertebral osteomyelitis using multislice linear X-ray tomography have been specified. The following is characteristic of tuberculous spondylitis: Mixed lytic destruction of vertebral bodies (p=0.04), anterior wedge-shaped deformation of the 2/3 and more of the vertebral body height (p=0.04), a rare damage of the arches, transverse and/or spinous processes (p=0.05). A diagnostic efficacy of the standard roentgenography, CT, tomosynthesis and a combination of tomosynthesis and US examination in revealing inflammatory changes in paravertebral tissues in patients with spinal tuberculosis has been determined. The sensitivity of the methods was 71.6, 90.2, 80.0 and 88.5% respectively, specificity amounted to 79.2, 93.1, 84.0 and 81.8%, respectively. The analysis of the diagnostic significance of the radiation techniques in differential diagnosis of tuberculosis and spinal osteomyelitis estimated the best values of sensitivity in CT (89.7%) and multislice linear digital X-ray tomography (84.6%) compared to the standard roentgenography (82.2%). Specificity was equal to 84.0, 79.3 and 76.1%, respectively. Conclusion. The combination of multislice linear digital X-ray tomography and US examination enables a significant reduction of radiation dose during examination of patients suspected of tuberculous spondylitis.