Skip to main content
Download PDF

MRI findings and classification of brucella spondylitis: a China multicenter study

European Journal of Medical Research volume 29, Article number: 469 (2024) Cite this article

Abstract

Objectives

To propose a magnetic resonance imaging (MRI) classification of brucellosis spondylitis (BS) to determine a standard treatment method and a standard of post-treatment MRI follow-up.

Methods

This is a multicenter retrospective cohort study. All patients diagnosed with BS at six hospitals for 12 years, were included in the study. Data were collected retrospectively from the medical records of the patients. The classification of the cases was based on MRI. We analyzed MRI features of BS was categorized them into three types.

Results

Six hundred fifteen patients were included in the study, 78.9% of whom were males. The mean age was 53.05 ± 11.06 years. Involvement of single vertebrae occurred in 6.2% of patients, while 72.7% involved two vertebrae and 21.1% involvement of more than two vertebrae. The most common of the lumbar spine was 64.6%. The main findings of MRI were affected vertebral endplate 2/3 above (60.7%), intervertebral space narrow (77.9%), intervertebral disc involvement (83.6%), paravertebral abscess (50.9%), disc abscess (49.6%), epidural abscess (43.3%), vertebra height change (22.1%), psoas abscess (22.0%), and abnormal vertebral accessory (10.2%). MR imaging of BS was categorized into three types. Type I: 57 (9.3%) patients; Type II: 526 (85.5%) patients, including IIa (26.5%), IIb (36.9%), and IIc (22.1%); Type IV: vertebral appendage type, 63 (10.2%) cases; Type III: 32 (5.2%) patients.

Conclusions

MRI features of multicenter data can provide theoretical support for diagnosing BS. MRI classification of BS can afford better help for clinical treatment and follow-up after clinical treatment.

Key Points

  • This is a China multicenter study on MRI features and classification in brucella spondylitis.

  • Multicenter MRI feature data can provide a reliable theoretical support for the classification of brucella spondylitis. MRI classification of brucella spondylitis can afford better help for clinical treatment and follow-up after clinical treatment.

Introduction

Brucellosis is a global zoonotic disease caused by intracellular Brucella species. It is a growing public health concern in high-risk countries and a neglected illness worldwide [1]. Brucellosis can occur in any organ, and the most common site is the skeletal system, with 10% to 85% of patients affected. Spinal involvement is the most common, with an infection rate of 54% [2]. Because brucella spondylitis (BS) is clinically nonspecific, it may be misdiagnosed and mistreated. Although low mortality rate, BS can be severely debilitating and disabling [3, 4]. It is critical to diagnose accurately and treat timely BS. There is no widely accepted radiological classification system based on objective results to guide in selecting a treatment method for BS. Therefore, it is urgent to improve clinicians' understanding of the imaging features of BS, and it is essential to screen firstly, relying on the imaging characteristics to determine whether it is BS. Between 2000 and 2019, research into the imaging characteristics of BS was done in Iran, Greece, Turkey, and Saudi Arabia [1]. However, these findings are different, due to the small sample size or other classification methods. There was a multicenter study to provide reliable imaging features and classification of BS, and its sample size was more extensive than previous studies [5,6,7]. Moreover, the extensive data on human BS should improve the identification of relevant prognostic factors and promote this debilitating condition’s clinical management. At present, there is no standardized magnetic resonance imaging (MRI) classification for BS. This paper proposes an MRI classification method for standardized treatment of the disease. This study aims to describe the MRI findings of 615 hospitalized patients with confirmed BS, and explore MRI features and classification in BS.

Materials and methods

This is a retrospective multicenter observational study from six medicine centers or departments that perform spinal MR examinations in China. BS patients from six hospitals were recruited as study cases with ethical approval for retrospective review of MR images by the local ethics committees, without the need for specific patient consent.

The radiologic database of each institution was searched for consecutive MRI studies performed during the ten years between January 1, 2010 and December 31, 2021 by looking for cases that fulfilled the following criteria [8, 9]: Diagnosis of BS was based on the Brucella agglutination titer test (≥ 1:160) and isolation of Brucella species from blood, bone marrow, or tissues and infection in the vertebra or intervertebral disc on MRI. The inclusion criteria include the following aspects. (I) Diagnosis confirmed by biopsy or culture from sample taken during surgery. (II) The patients who had undergone an MRI. III. All patients were supposed to be adults (Age > 18 year). The exclusion criteria were as follows: (I) The patients who had congenital spinal dysplasia. (II) Patients with spinal dysplasia or suspected cancer. (III) The patients received any surgery or medication before the study.

Analysis of imaging

The following was recorded on BS patients: patients’ age, sex, nationality, and MRI findings. MRI findings including the location of involvement in the spine (cervical, cervicothoracic, thoracic, thoracolumbar, lumbar, lumbosacral, or sacral), multiple noncontiguous levels, vertebral height (normal or compression), vertebral number (one, two, or > 2), location of vertebral destruction (posterior 1/3 of vertebral endplate, middle 1/3 of vertebral endplate, anterior 1/3 of vertebral endplate, more than 2/3 of vertebral endplate), the height of intervertebral space (normal, narrow ≤ 1/2, or narrow > 1/2), intervertebral disc destruction (normal, destruction grading ≤ 1/2, or destruction grading > 1/2), abnormal vertebral accessory structure (pedicle, spinous process, or transverse process), abscess (intervertebral disc abscess, epidural abscess, psoas abscess) [10].

BS was matched according to MRI finding classification [11]: Type I (Early stage): vertebral inflammatory edema type, BS showed only vertebral marrow edema without/with paravertebral edema, a hypointense signal on T1WI, and hyperintense signal on T2WI (Fig. 1a). Type II (Progressive stage): vertebral bone destruction and bone repair coexist, and the degree of bone destruction is greater than that of bone repair. This type has three sub-types: IIa, IIb, and IIc. Type IIa: MRI revealed 1/3 of the vertebra endplate destruction, vertebral height normal, without abscess (Fig. 1b); Type IIb: MRI showed more than 2/3 of the vertebral endplate destruction, vertebral height normal (Fig. 1c); Type IIc: MRI presented destruction of vertebral endplate 2/3 above, vertebral compression (Fig. 1d). Type III (Repair stage): bone destruction and bone repair coexist, and the degree of bone repair is greater than that of bone destruction (Fig. 1e). The vertebral lesion showed a homogeneous/heterogeneous hypointense signal on T1WI and homogeneous/heterogeneous hypointense signal on T2WI. The edge of the lesion is sclerosed.

Fig. 1
figure 1

This is the schematic diagram of BS imaging classification. The area marked red represents bone marrow edema and abscess formation. The blue area is bone destruction, and the black area is bone hyperplasia and sclerosis

Full size image

MRI data were collected by six radiologists (from 6 hospitals) who each had more than eight years of experience. Before these data were collected, six doctors were trained online. Training results were tested using 10 patients, and the Kappa consistency was 8.991.

Statistical analysis

Statistical analysis was performed with SPSS17.00 statistical software. Continuous variables were shown as mean ± standard deviation, and categorical variables were presented as percentages.

Results

Demographic characteristics

Demographic characteristics of patients with BS are shown in Table 1. This study evaluated 615 patients with BS. The study population consisted of 485 men and 130 women, and the ratio was 3.7 to 1. The mean age was 53.05 ± 11.06 (range 19–82) years. The incidence of ethnic groups is 44.9% Han, 34% Uygur, 10.2% Kazak, 8.3% Hui, 1.6% Mongol, and 0.1% other nationalities.

Table 1 Demographic characteristics of brucella spondylitis patients
Full size table

MRI findings

MRI characteristics of BS patients are shown in Table 2. Of the 615 patients with BS, thirty-eight patients had a single vertebrae, 447 (72.7%) had involvement of two vertebrae whereas 130 (21.1%) had more than two regions. The lumbar spine is the commonest affected region (397 patients, 64.4%), while the lumbosacral spine was affected in 118 (18.5%) patients, thoracic spine affected in 35 (5.7%) patients, cervical spine in 16 (2.6%) patients, while thoracolumbar spine was affected in 8 (1.3%) patients, sacral spine was affected in 3 (0.5%) patients and cervicothoracic spine was affected in 2 (0.3%) patients.

Table 2 MRI characteristics of brucella spondylitis patients
Full size table

Of the 615 patients with BS, vertebra height was collapsed in 136 (22.1%) patients, while the remaining vertebra height was normal. The most common was involvement of more than 2/3 of the endplate, accounting for 373 (60.7%) patients, followed by 118 (19.2%) posterior of endplate 1/3, 98 (15.9%) anterior of endplate 1/3, 26 (4.2%) middle of endplate 1/3. The vertebral appendices of 63(10.2%) patients were infected by Brucella.

Of the 615 patients with BS, no more than 1/2 of the intervertebral space height was altered in 323 (52.5%) patients, and 156 (25.4%) patients with intervertebral space were changed more than 1/2, while 136 (22.1%) patients with intervertebral space were normal.

Of the 615 patients with BS, intervertebral disc involvement was observed in 453 patients. Of the patients with intervertebral disc involvement, 297 (48.3%) cases had the destruction grading (≤ 1/2) of the intervertebral disc, and 156 (25.4%) patients with the destruction grading (> 1/2) of the intervertebral disc.

Of the 615 patients with BS, the most common abscess formation was the paravertebral abscess (313, 50.9%) patients, followed by 305 (49.6%) disc abscess, 266 (43.3%) epidural abscess, 135 (22.0%) psoas abscess. In paravertebral abscess, epidural abscess, and psoas abscess, the abscess beyond the adjacent vertebral bodies had 77 (12.5%) patients, while the abscess in the adjacent vertebral bodies had 88.5% of patients.

MRI classification

Type I. It has 57 (9.3%) patients. 38 (6.2%) involved a single vertebrae, and 19 (3.1%) involved two vertebrae (Fig. 1a, Fig. 2a). A total of 76 vertebrae presented marrow edema. There were 33 (5.4%) patients for anterior 1/3 of the vertebral endplate destruction and 24 (3.9%) for posterior 1/3 of the vertebral endplate destruction. Type II. It has 526 (85.5%) patients, including IIa (163), IIb (237), and IIc (136). Type IIa has 163 (26.5%) patients with vertebral height normal and without abscess (Fig. 1b, Fig. 2b), including 84 (13.7%) the posterior vertebral endplate destruction, 55 (8.9%) the anterior vertebral endplate destruction, 24 (3.9%) the middle vertebral endplate destruction, 57 (9.3%) intervertebral space normal, 84 (13.7%) intervertebral space narrow, 22 (3.6%) without intervertebral disc destruction, 141 (22.9%) with intervertebral disc destruction, a hypointense signal on T1WI and hyperintense signal on T2WI. Type IIb has 227 (36.9%) patients with vertebral height normal, more than 2/3 of the vertebral endplate destruction, abscess, intervertebral space narrow, intervertebral disc destruction (Fig. 1c, Fig. 2c), homogeneous/heterogeneous hypointense signal on T1WI, and homogeneous/heterogeneous hyperintense signal on T2WI. The abscess occurred in 180 (29.3%) intervertebral disc abscesses, 147 (23.9%) epidural abscesses, 59 (9.6%) psoas muscle abscesses, 27 (4.48%) paravertebral abscesses. Type IIc has 136 (22.1%) patients with vertebral wedge-shaped, more than 2/3 of the vertebral endplate destruction, intervertebral space narrow, intervertebral disc destruction (Figs. 1d, 2d), homogeneous/heterogeneous hypointense signals on T1WI, and heterogeneous signals on T2WI. Among them, there were 125 intervertebral disc abscesses (20.38%), 119 epidural abscesses (19.3%), 109 paravertebral abscesses (17.7%), and 76 psoas muscle abscesses (12.4%). Type III. There were 32 patients (5.2%). Seventeen (2.8%) patients with BS showed a hypointense signal on T1WI and T2WI. 15 (2.4%) patients with BS showed a hypointense signal on T1WI and a heterogeneous hypointense signal on T2WI (Figs. 1e, 2e).

Fig. 2
figure 2

This is MRI of BS image classification

Full size image

Discussion

This study retrospectively collected multicenter data from MRI features of 615 patients with BS in China. The results provided a theoretical basis for diagnosis in MRI and classification of BS. To our knowledge, this study had the most data on MRI features compared with previous studies, and the MRI classification of BS was few reported.

The patients’ mean age was 53 years (range 19–82 years), consistent with previous studies [8, 12,13,14,15,16,17]. Male patients predominated (64–74%) [14, 15]. In our study, the male patients’ ratio was higher (78.9%), similar to studies by Çıraklı et al. [18]. This may be the nature of the male job in such regions, facilitating increased exposure to animals and their products, as observed in herders, ranchers, pastoralists, and abattoir workers [17]. In the current study, the most common nationality is Han (44.9%), followed by Uygur (34.0%), Kazak (10.2%), Hui (8.3%), Mongol (1.6%), and Other (0.1%).

MRI has a high diagnostic sensitivity, specificity, and accuracy of > 90% in spinal infection [19,20,21,22,23]. MRI is the diagnostic imaging modality of BS [12, 24], the most valuable method to diagnose BS [25, 26]. It is stated that most sites involved in the lumbar, followed by the thoracic, and cervical segments, are reported to be more involved in BS [18, 27,28,29,30,31,32,33,34,35,36,37,38,39,40,41]. In the current study, the sites of involvement were lumbar (64.6%), lumbosacral (18.5%), thoracic (5.7%), cervical (2.6%), thoracolumbar (1.3%), sacral (0.5%) and cervicothoracic (0.3%). Compared with previous studies, the incidence of involvement in the lumbar is similar to previous studies [14, 18, 27,28,29,30,31,32,33,34,35,36,37,38,39,40,41], and the rate of the lumbosacral region is higher than that of previous studies [14, 38, 41], whereas the rate of the thoracic [14, 18, 27,28,29,30,31,32,33,34,35,36,37,38, 40], cervical [14, 28,29,30,31,32,33,34,35,36,37,38,39,40,41], thoracolumbar [14, 38, 39, 41] and cervicothoracic [39] region is lower than that of previous studies. This difference may be related to multicenter, extensive data studies.

BS can be seen as single-focal and contiguous or non-contiguous multi-focal involvements. It was reported that involvement of a single spinal region has predominated (91–95.5%) [24, 39], and multiple regions have different results in different literatures (3–36%) [24, 30, 31, 35, 38, 39, 41,42,43,44,45,46,47,48,49,50]. In this study, the most common were lesions involving two vertebral bodies (72.7%), followed by lesions involving more than two vertebral bodies (21.1%), and lesions involving one vertebral body (6.2%). 40 (6.5%) had noncontiguous multifocal spinal involvement in our study, a figure lower than those reported in the literature [39, 46, 51].

Due to the rich blood supply of the superior endplate, the superior endplate is the usual starting point in most spinal brucellosis, although the inferior endplate may also be involved [41]. In MRI, the lesion is destructive in an anterosuperior corner of the vertebrae, accompanied by prominent osteosclerosis [52, 53]. When the balance between the organism’s virulence and host defense mechanism is destroyed, disease progression can involve the entire vertebral body [41]. Therefore, the vertebrae of BS is abnormally altered with focal or diffuse bone destruction. In focal involvement, the lesion is localized in the anterior endplate 1/3, middle of endplate 1/3, and posterior endplate 1/3 at the vertebral junction. Still, in the diffuse type, the lesion affects the vertebral endplate 2/3 above or the whole vertebral body [31, 54]. In this study, the location of vertebral destruction was vertebral endplate 2/3 above (60.7%), posterior of endplate 1/3 (19.2%), anterior of endplate 1/3 (15.9%), middle of endplate (4.2%). 10.9 percent of patients with vertebral appendages were abnormal.

The superior endplate is the first part of the vertebrae involved because of its rich blood supply wich causes bone destruction in the early stages. The inflammation can spread to the entire vertebrae and may involve the adjacent disc space [41]. Vertebral collapse may lead to vertebral compression fracture resulting in vertebral flattening. In the current study, vertebra height was altered in 22.1% of patients, while the remaining patients’ vertebra height was normal.

Of the 615 patients with BS, intervertebral disc involvement was observed in 73.7% patients. Of the patients with intervertebral disc involvement, 48.3% had the destruction grading (≤ 1/2) of the intervertebral disc, and 25.4% of patients with the destruction grading (> 1/2) of the intervertebral disc. Intervertebral disc damage may cause the intervertebral space narrow. In our study, no more than 1/2 of the intervertebral space height was altered in 52.5% of patients, and 25.4 percent of patients with intervertebral space was changed more than 1/2, while 22.1% of patients with intervertebral space was normal. Disease progression is inevitable when the balance between the organism’s virulence and host defense mechanism is destroyed. Finally, the process can involve the entire vertebral body, invade the neighboring intervertebral disc space, and invade adjacent vertebrae [41].

BS may also occur in psoas abscess, paraspinal abscess, and/or epidural abscess [2, 30, 55]. According to the report, the incidence of abscess formation findings was 29–65.6% [17, 34, 36]. Paravertebral abscesses have been reported to occur at a frequency of 13.6–30% in three studies [24, 32, 50]. Both paravertebral [14, 15, 17, 38, 39] and epidural [14, 38, 39] abscess formations were reported. In the current study, the incidence of findings of abscess formation was paravertebral abscesses (63.4%), disc abscesses (49.6%), epidural abscesses (43.3%), and psoas abscesses (22.0%). All abscesses may occur in a single form or multiple combinations. According to the imaging findings, paravertebral abscesses were divided beyond the adjacent vertebral bodies (12.5%) and the adjacent vertebral bodies (50.9%). If abscesses are found, a longer course of treatment and even surgical intervention may be needed.

MRI classification

In previous studies, BS was classified into the following five types according to imaging characteristics: vertebral osteomyelitis, discitis, paravertebral abscess or epidural abscess, and mixed type [5, 6]. Such a comprehensive imaging classification is not conducive to treating BS and post-treatment imaging follow-up. As MRI has a high diagnostic sensitivity, specificity, and accuracy in BS, the MRI classification of BS may be more conducive to the diagnosis, treatment, and prognosis follow-up of BS. In the current study, MRI findings were classified into the following three types according to the progression of spinal lesions. Type I (Early stage): vertebral inflammatory edema type, these patients can pass non-hand Surgical treatment and cure [7]. Type II (Progressive stage): vertebral bone destruction and bone repair coexist, and the degree of bone destruction is greater than that of bone repair. This type has three sub-types: IIa, IIb, and IIc. In Type IIa, the vast majority of patients can pass non-hand Surgical treatment and cure. When does not respond to medication, surgical treatment can be considered patients [6, 7]. In Type IIb and Type IIc, under the premise of effective drug treatment, minimally invasive or open surgical treatment can be selected according to different image credit types [7]. Type III (Repair stage): bone destruction and bone repair coexist, and the degree of bone repair is greater than that of bone destruction. The lesions of BS tend to heal, and the vast majority of patients do not need treatment. In the current study, the proportion of Type I and Type III was 9.3% and 5.2%, which were relatively small. The possible reason is that BS is a chronic disease with no early clinical symptoms or atypical clinical symptoms, which make it easy to delay diagnosis. Since there are few patients with type I BS when the patients with type I BS are treated with drugs, fewer patients with BS change to the repair stage (type III). We propose a classification system using the MRI information to help plan the appropriate and rational treatment for patients with BS.

This analysis has several limitations. Firstly, this was a retrospective study and therefore was susceptible to uncontrolled confounding. Secondly, the quality of images obtained by different parameters and MRI from other manufacturers in six hospitals was biased. Last but not least, all data was collected by the six investigators, thereby maximizing bias due to differences in data interpretation and admission coding.

In conclusion, we report the most extensive multicenter cohort study of MRI features and classification with BS. MRI features and classification of BS can provide better help for clinical diagnosis and treatment.

Availability of data and materials

Our data and images support the usability of our articles.

Abbreviations

BS:

Brucella spondylitis

MRI:

Magnetic resonance imaging

T1WI:

T1 weighted image

T2WI:

T2 weighted image

References

  1. Adetunji SA, Ramirez G, Foster MJ, Arenas-Gamboa AM. A systematic review and meta-analysis of the prevalence of osteoarticular brucellosis. Plos Negl Trop Dis. 2019;13: e0007112.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Esmaeilnejad-Ganji SM, Esmaeilnejad-Ganji SMR. Osteoarticular manifestations of human brucellosis: a review. World J Orthop. 2019;10:54–62.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Franco MP, Mulder M, Gilman RH, Smits HL. Human brucellosis. Lancet Infect Dis. 2007;7:775–86.

    Article  CAS  PubMed  Google Scholar 

  4. Corbel MJ. Brucellosis: an overview. Emerg Infect Dis. 1997;3:213–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Lan X, Gao J, Xu JZ, Liu XM. Imaging classification and its treatment choice of brucellosis spondylitis. Chin J Bone Jt Injury. 2017;32:40–3.

    Google Scholar 

  6. Zhang PN, Yang XM, Meng XY, Yin YL, Wu W, Cui SJ. Imaging classification of Brucellosis spondylitis. J Hebei Med Univ. 2015;3:334–7.

    Google Scholar 

  7. Hinners J. Vertebral osteomyelitis and the role of imaging. Radiol Technol. 2017;88:519–35.

    PubMed  Google Scholar 

  8. Tuurgut M, Turgut AT, Kosar U. Spinal brucellosis: Turkish experience based on 452 cases published during the last century. Acta Neurochir. 2006;148:1033–44.

    Article  Google Scholar 

  9. Oztekin O, Calli C, Adibelli Z, Kitis O, Eren C, Altinok T. Brucellar spondylodiscitis: magnetic resonance imaging features with conventional sequences and diffusion-weighted imaging. Radiol Med. 2010;115:794–803.

    Article  CAS  PubMed  Google Scholar 

  10. Gao M, Sun JM, Jiang ZS, et al. Comparison of tuberculous and brucellar spondylitis on magnetic resonance images. Spine. 2017;42:113–21.

    Article  PubMed  Google Scholar 

  11. Zhang N, Zeng X, He L, et al. The value of MR imaging in comparative analysis of spinal infection in adults: pyogenic versus tuberculous. World Neurosurg. 2019;128:e806–10.

    Article  PubMed  Google Scholar 

  12. Pola E, Autore G, Formica VM, et al. New classifcation for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years. Eur Spine J. 2017;26:479–88.

    Article  PubMed  Google Scholar 

  13. Yang X, Zhang Q, Guo X. Value of magnetic resonance imaging in brucellar spondylodiscitis. Radiol Med. 2014;119:928–33.

    Article  PubMed  Google Scholar 

  14. Buzgan T, Karahocagil MK, Irmak H, et al. Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis. 2010;14:e469-478.

    Article  PubMed  Google Scholar 

  15. Colmenero JD, Ruiz-Mesa JD, Plata A, et al. Clinical findings, therapeutic approach, and outcome of brucellar vertebral osteomyelitis. Clin Infect Dis. 2008;46:426–33.

    Article  PubMed  Google Scholar 

  16. Bosilkovski M, Krteva I, Caparoska S, et al. Osteoarticular involvement in brucellosis: a study of 196 cases in the Republic of Macedonia. Croat Med J. 2004;45:727–33.

    PubMed  Google Scholar 

  17. Lan SQ, He YL, Tiheiran M, Liu WY, Guo H. The Angiopoietin-like protein 4: a promising biomarker to distinguish brucella spondylitis from tuberculous spondylitis. Clin Rheumatol. 2021;40:4289–94.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Namiduru M, Karaoglan I, Gursoy S, Bayazit N, Sirikci A. Brucellosis of the spine: evaluation of the clinical, laboratory, and radiological findings of 14 patients. Rheumatol Int. 2004;24:125–9.

    Article  PubMed  Google Scholar 

  19. Çıraklı S, Karlı A, Şensoy G, Belet N, Yanık KC, Çıraklı A. Evaluation of childhood brucellosis in the central Black Sea region. Turk J Pediatr. 2015;57:123–8.

    PubMed  Google Scholar 

  20. Kourbeti IS, Tsiodras S, Boumpas DT. Spinal infections: evolving concepts. Curr Opin Rheumatol. 2008;20:471–9.

    Article  PubMed  Google Scholar 

  21. Trombly R, Guest JD. Acute central cord syndrome arising from a cervical epidural abscess: case report. Neurosurgery. 2007;61:E424-425.

    Article  PubMed  Google Scholar 

  22. Palestro CJ, Love C, Miller TT. Infection and musculoskeletal conditions: imaging of musculoskeletal infections. Best Pract Res Clin Rheumatol. 2006;20:1197–218.

    Article  PubMed  Google Scholar 

  23. Butler JS, Shelly MJ, Timlin M, Powderly WG, O’Byrne JM. Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine. 2006;31:2695–700.

    Article  PubMed  Google Scholar 

  24. Moritani T, Kim J, Capizzano AA, Kirby P, Kademian J, Sato Y. Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections. Br J Radiol. 2014;87:20140011.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Bozgeyik Z, Ozdemir H, Demirdag K, Ozden M, Sonmezgoz F, Ozgocmen S. Clinical and MRI findings of brucellar spondylodiscitis. Eur J Radiol. 2008;67:153–8.

    Article  PubMed  Google Scholar 

  26. Reşorlu H, Saçar S, Inceer BŞ, et al. Cervical spondylitis and epidural abscess caused by brucellosis: a case report and literature review. Folia Med. 2016;58:289–92.

    Article  Google Scholar 

  27. Bagheri AB, Ahmadi K, Chokan NM, et al. The diagnostic value of MRI in BS with comparison to clinical and laboratory findings. Acta Inform Med. 2016;24:107–10.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Guo H, Lan SQ, He YL, Tiheiran M, Liu WY. Diferentiating brucella spondylitis from tuberculous spondylitis by the conventional MRI and MR T2 mapping: a prospective study. Eur J Med Res. 2021;26:125.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Skalsky K, Yahav D, Bishara J, Pitlik S, Leibovici L, Paul M. Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials. BMJ. 2008;336:701–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Erdem H, Elaldi N, Batirel A, et al. Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter “Backbone-1 Study.” Spine J. 2015;15:2509–17.

    Article  PubMed  Google Scholar 

  31. Mrabet D, Mizouni H, Khiari H, et al. Brucellar spondylodiscitis affecting non-contiguous spine levels. BMJ Case Rep. 2011;2011:bcr0120113788.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Bozgeyik Z, Aglamis S, Bozdag PG, Denk A. Magnetic resonance imaging findings of musculoskeletal brucellosis. Clin Imaging. 2014;38:719–23.

    Article  PubMed  Google Scholar 

  33. Tekaya R, Tayeb MH, El Amri N, et al. Brucella spondylodiscitis: a study of nineteen cases. Ann Rheum Dis. 2015;74:290.

    Article  Google Scholar 

  34. Koubaa M, Maaloul I, Marrakchi C, et al. Spinal brucellosis in South of Tunisia: review of 32 cases. Spine J. 2014;14:1538–44.

    Article  PubMed  Google Scholar 

  35. Chelli Bouaziz M, Ladeb MF, Chakroun M, Chaabane S. Spinal brucellosis: a review. Skeletal Radiol. 2008;37:785–90.

    Article  PubMed  Google Scholar 

  36. Kaptan F, Gulduren HM, Sarsilmaz A, et al. Brucellar spondylodiscitis: comparison of patients with and without abscesses. Rheumatol Int. 2013;33:985–92.

    Article  PubMed  Google Scholar 

  37. Colmenero JD, Jimenez-Mejias ME, Sanchez-Lora FJ, et al. Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis. 1997;56:709–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Pourbagher A, Pourbagher MA, Savas L, et al. Epidemiologic, clinical, and imaging fifindings in brucellosis patients with osteoarticular involvement. AJR Am J Roentgenol. 2006;187:873–80.

    Article  PubMed  Google Scholar 

  39. Solera J, Lozano E, Martinez-Alfaro E, et al. Brucellar spondylitis: review of 135 cases and literature survey. Clin Infect Dis. 1999;29:1440–9.

    Article  CAS  PubMed  Google Scholar 

  40. Turunc T, Demiroglu YZ, Uncu H, Colakoglu S, Arslan H. A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect. 2007;55:158–63.

    Article  PubMed  Google Scholar 

  41. Ozaksoy D, Yucesoy K, Yucesoy M, Kovanlikaya I, Yuce A, Naderi S. Brucellar spondylitis: MRI findings. Eur Spine J. 2001;10:529–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Ariza J, Gudiol F, Valverde J, et al. Brucellar spondylitis: a detailed analysis based on current findings. Rev Infect Dis. 1985;7:656–64.

    Article  CAS  PubMed  Google Scholar 

  43. Liang C, Wei W, Liang XW, De EJ, Zheng BW. Spinal brucellosis in Hulunbuir, China, 2011–2016. Infect Drug Resist. 2019;12:1565–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Baqer MM, Qurtom MA, Abdulhadi Ali Al-Ajmi J, Collier BD, Elgazzar AH. Multifocal brucellosis spondylodiscitis. Clin Nucl Med. 2002;27:842–3.

    Article  PubMed  Google Scholar 

  45. Shalchian S, de Wispelaere F. Brucella spondylodiscitis with multiple-level involvement, an unusual clinical presentation. Eur J Neurol. 2007;14:e1-2.

    Article  CAS  PubMed  Google Scholar 

  46. Ozden M, Demirdag K, Kalkan A, Ozdemir H, Yuce P. A case of brucella spondylodiscitis with extended, multiple-level involvement. South Med J. 2005;98:229–31.

    Article  PubMed  Google Scholar 

  47. Raptopoulou A, Karantanas AH, Poumboulidis K, Grollios G, Raptopoulou-Gigi M, Garyfallos A. Brucellar spondylodiscitis: noncontiguous multifocal involvement of the cervical, thoracic, and lumbar spine. Clin Imaging. 2006;30:214–7.

    Article  PubMed  Google Scholar 

  48. Bouaziz MC, Bougamra I, Kaffel D, Hamdi W, Ghannouchi M, Kchir MM. Noncontiguous multifocal spondylitis: an exceptional presentation of spinal brucellosis. Tunis Med. 2010;88:280–4.

    PubMed  Google Scholar 

  49. Zormpala A, Skopelitis E, Thanos L, Artinopoulos C, Kordossis T, Sipsas NV. An unusual case of brucellar spondylitis involving both the cervical and lumbar spine. Clin Imaging. 2000;24:273–5.

    Article  CAS  PubMed  Google Scholar 

  50. Harman M, Unal O, Onbasi KT, Kiymaz N, Arslan H. Brucellar spondylodiscitis: MRI diagnosis. Clin Imaging. 2001;25:421–7.

    Article  CAS  PubMed  Google Scholar 

  51. Colmenero JD, Cisneros JM, Orjuela DL, et al. Clinical course and prognosis of brucella spondylitis. Infection. 1992;20:38–42.

    Article  CAS  PubMed  Google Scholar 

  52. Mehanic S, Baljic R, Mulabdic V, et al. Osteoarticular manifestations of brucellosis. Med Arch. 2012;66:24–6.

    Article  PubMed  Google Scholar 

  53. Tuna N, Ogutlu A, Gozdas HT, Karabay O. Pedro Pons’ sign as a Brucellosis complication. Indian J Pathol Microbiol. 2011;54:183–4.

    Article  PubMed  Google Scholar 

  54. Arkun R, Mete BD. Musculoskeletal brucellosis. Semin Musculoskelet Radiol. 2011;15:470–9.

    Article  PubMed  Google Scholar 

  55. Mantur BG, Amarnath SK, Shinde RS. Review of clinical and laboratory features of human brucellosis. Indian J Med Microbiol. 2007;25:188–202.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge the financial support provided by State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia Fund (Grant No. SKL-HIDCA-2021-22).

Funding

The authors gratefully acknowledge the financial support provided by State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia Fund (Grant No. SKL-HIDCA-2021-22).

Author information

Authors and Affiliations

  1. Digestive Internal Medicine, People’s Hospital of Xinjiang Uyghur Autonomous Region, Ürümqi, People’s Republic of China

    Li Gou

  2. Radiology Department, Xinjiang Medical University Affiliated Eight Hospital, Ürümqi, People’s Republic of China

    Yuxin Yang

  3. Radiology Department, People’s Hospital of Inner Mongolia Autonomous Region, Hohhot, People’s Republic of China

    Junlin Li

  4. Radiology Department, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China

    Lei Cai

  5. Radiology Department, The Fifth Hospital of Shijiazhuang, Shijiazhuang, People’s Republic of China

    Weihong Xing

  6. Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Ürümqi, People’s Republic of China

    Wenya Liu

  7. Medical Imaging Center, Xinjiang Medical University Affiliated Four Hospital, Ürümqi, People’s Republic of China

    Hui Guo

  8. Radiology Department, Beijing Youan Hospital of Capital Medical University, Beijing, People’s Republic of China

    Hongjun Li

  9. Radiology Department, Henan Infectious Disease Hospital, Zhengzhou, People’s Republic of China

    Lingling zhao

  10. Guangxi AIDS Clinical Treatment Center, The Fourth People’s Hospital of Nanning, Nanning, People’s Republic of China

    Yibo Lu

Authors
  1. Li Gou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuxin Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Junlin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lei Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Weihong Xing
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wenya Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hui Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hongjun Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lingling zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yibo Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: Hui Guo, Wenya Liu, and Hongjun Li. Performed research: Li Gou, Hui Guo, and Wenya Liu. Analyzed data: Li Gou, Yuxin Yang, Junlin Li, Lei Cai, and Weihong Xing. Wrote the paper: Li Gou and Hui Guo. Revised the paper: Lingling Zhao and Yibo Lu. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Hui Guo or Hongjun Li.

Ethics declarations

Ethics approval and consent to participate

Ethical approval for the study was obtained from the ethical review committee for the first affiliated hospital of Xinjiang Medical University.

Consent for publication

We declare our consent to publication.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gou, L., Yang, Y., Li, J. et al. MRI findings and classification of brucella spondylitis: a China multicenter study. Eur J Med Res 29, 469 (2024). https://doi.org/10.1186/s40001-024-02011-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s40001-024-02011-2

Keywords

European Journal of Medical Research

ISSN: 2047-783X

Contact us