Table 2.

Clinical and MRI features to differentiate tubercular from pyogenic infections (

modified from: Frel et al. [95])

	Pyogenic spondylitis	Tuberculous spondylitis
Patient characteristics and clinical symptoms
Age	Relatively old	Relatively young
Duration to diagnosis	Relatively short symptom to diagnosis interval	Relatively long symptom to diagnosis interval
History	Recent distant bacterial infection or previous spinal surgery	History of TBC infection or current extraspinal manifestations
Onset	Acute or subacute	Subacute
Fever	More frequent associated high fever, acute sepsis	Intermitted fever
ESR, CRP, WCC	Markedly increased	Mild increased
MRI features
Involvement of vertebral bodies	Involvement ≤ 2 vertebral bodies	Multiple body involvement
Severity of destruction of vertebral bodies	Infrequent and mild to moderate	Frequent and more severe
Disc destruction	Severe to complete disc destruction	Normal to mild disc destruction
Loss of cortical definition	Absent	Present
Areas of paraspinal enhancement	Poorly demarcated contrast	Well-demarcated contrast
Vertebral signal in T2 images	Hyperintense/homogeneous	Heterogeneous
Vertebral enhancement	Diffuse/homogeneous	Focal/heterogeneous
Paraspinal abscess	39–40% of cases	75% of cases
Epidural abscess	11–15% of cases	56–60% of cases
Abscess wall	Thick and irregular	Thin and smooth
Meningeal enhancement at the affected vertebral level	28–30% of cases	> 75% of cases
Subligamentous spread to 3 or more vertebral bodies	Absent	Present
Spinal deformity	Absent	Present
Thoracic spine involvement	Absent	Present

MRI magnetic resonance imaging, ESR erythrocyte sedimentation rate, CRP C-reactive protein, WCC white cell count