• Diffusion-weighted imaging (DWI) with a b-value of 400 s/mm2 yields the highest diagnostic accuracy (sensitivity 95%, specificity 96.67%) for differentiating spinal tuberculosis from Brucellar spondylitis.
• ADC values of affected vertebral bodies are significantly higher in spinal tuberculosis than in Brucellar spondylitis across all tested b-values (0, 200, 400, 600, 800 s/mm2).
• ADC values at different b-values correlate significantly with inflammatory markers (ESR, CRP, WBC), linking imaging findings to systemic inflammation.
• DWI demonstrates excellent inter-observer reliability (ICC > 0.75), supporting its clinical utility as a non-invasive diagnostic tool.