Radiologic Changes in Brucella Spondylitis

Background/ Objectives: Brucellosis is an endemic zoonosis in the Middle East and despite all public health efforts it has not yet been eradicated in Iran. We aimed to highlight and categorize the imaging features of Brucella spondylitis. Material and Method: Twenty six cases of Brucella spondylitis were treated by the authors from 1982 up to 2003. The available imaging studies of all the cases are reviewed and include X-ray films, conventional myelography, computerized tomographic (CTscan) and magnetic resonance imaging (MRI). Results: There were 21 male and 5 female patients with an age range of 5 to 62 years and the majority (60%) in the 4th and 5th decades of life. Wright hemagglutination tests were positive in all cases. Plain X-ray films typically showed lysis of the end plates with osteophyte formation involving affected vertebrae, followed by narrowing of the interspaces and destruction or collapse of the vertebral bodies in 7 cases. Myelography demonstrated various types of epidural filling defects and obstruction to the flow of contrast material in 10 cases. CT scan, available in 3 cases, showed erosion and cauliflower-like proliferation at the bony edges of the vertebral bodies and end plates. MRI findings varied depending upon the acute or chronic stages of the illness with hypo- or hyper-intense changs on T1 sequences, and primarily hyper-intense changes on T2 sequences in 8 cases. Conclusion: The findings in this series of patients suggest that imaging findings of Brucella spondylitis are scarcely specific. However when considering the medical history, place of origin of the patients, clinical presentation and laboratory findings, the early diagnosis of the illness may be possible before proceeding to surgical intervention.