Siddharth Sanjay Shah* and Arvind Balkrishna Goregaonkar


Introduction: MRI is a highly sensitive and specific, noninvasive investigation for early diagnosis of spinal tuberculosis without hazards of radiation. However, a clear consensus is lacking, as to what defines a tubercular lesion on a spine MRI. This study was aimed at establishing the commonest diagnostic features of spinal tuberculosis on MRI. Methods: Thirteen consecutive spinal tuberculosis patients (5 males, 8 females), diagnosed either bacteriologically by culture or clinico-radiologically, were studied retrospectively for the pathological features of tuberculosis on their pre-treatment MRI. Results: Thoracic (76.9%, most common), lumbar (38.5%) and cervical (7.7%) regions were involved. 40 affected vertebrae were noted, mean 3.1 vertebrae, with 92.3% patients having multiple vertebral involvement. All pathological lesions were T1W hypointense and T2W hyperintense. Central body lesions (84.6%) were more common than paradiscal lesions (69.2%). Kyphotic collapse (76.9%; greater in paradiscal lesions), vertebra plana (23.1%), disc signal changes (84.6%, with 61.5% having reduced space), end plate erosion (69.2%), end plate destruction (46.1%) and cord edema (61.5%) were seen, without myelomalacia or syrinx formation. Canal stenosis was seen in 100% patients, only 61.5% patients had neurodeficit. Abscess collection (76.9%), with spread in subligamentous space (70%), epidural space (60%) and along psoas (40%) were seen. Marrow edema was noted in 100% cases. Central vertebral lesion, disc intensity changes, marrow edema and canal stenosis were observed in combination in 84.6% patients. Conclusion: MRI is an indispensible modality of primary investigation in suspected cases of spinal tuberculosis. Canal stenosis, marrow edema, central vertebral body involvement, disc intensity changes and abscess collection are the most consistent MRI features of TB spine.

Keywords: Tuberculosis; Magnetic resonance imaging; MRI; Diagnosis; Early diagnosis.

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