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Background  Brucella spondylitis (BS) and tuberculous spondylitis (TS), caused initially by bacteremia, are the two leading types of granulomatous spinal infections. BS is easy to miss or may be misdiagnosed as TS. Our purpose aims to differentiate BS from TS in conventional MR imaging and MR T2 mapping.    Methods  We performed on 26 BS and 27 TS patients conventional MR imaging and MR T2 mapping. We analyzed the features in conventional MR imaging and measured T2 values of the lesion vertebrae (LV) and unaffected adjacent vertebrae (UAV) in BS and TS patients, respectively.    Results  There were no significant differences in sex, age, national between BS and TS. There was significantly lower severity of vertebral destruction, vertebral posterior convex deformity, dead bone, and abscess scope in BS when compared to TS ( p   <  0.001,  p   =  0.048,  p   <  0.001,  p   <  0.001, respectively). The vertebral hyperplasia was significantly higher in BS when compared to TS ( p   <  0.001). The T2 value of the LV with BS was markedly higher than that in the UAV with BS and that in the LV and UAV with TS ( p   <  0.001,  p   <  0.037,  p   <  0.001, respectively). The T2 value of the LV with TS was significantly higher than that of the UAV in TS and BS ( p   <  0.001,  p   <  0.001, respectively). There were no significant differences in the T2 value of the UAV between BS and TS ( p   =  0.568).    Conclusions  The qualitative and quantitative evaluation may differentiate BS from TS. The conventional MR imaging helps to distinguish BS from TS by several distinctive features. MR T2 mapping has the additional potential to provide quantitative information between BS and TS.

Differentiating brucella spondylitis from tuberculous spondylitis by the conventional MRI and MR T2 mapping: a prospective study