After ethical review committee approval,
we conducted this cross sectional study at Radiology department of JPMC from july to december 2016.
Out of a total of 2995 MRI of spine,
51 cases were found to have TB of spine; confirmed on histopathology.
The scanning was performed on 1.5T Achieva Nova Philips scanner and 0.3T Hitachi(open scanner).
The patients included in the study had a backache of three months duration.
Their MR features included involvement of endplates and vertebral bodies along with prevertebral,
epidural and paraspinal collections.
The patients who had TB and were on treatment,
post traumatic,
post surgical,
metastatic and degenrative spines were excluded from the study.
The patients whose histopathology was not available were also excluded.
A neuroradiologist with a postfellowship experience of five years read the scans.
Few of the cases with tuberculous spine/ Pott's disease are shared below:-
Case 1:
Fig. 1: 57 years old male with backache. Intraosseous tb abscesses are seen in lower dorsal vertebrae with peripheral thick enhancing walls seen on T1W post gadolinium images
Fig. 2: 57 years old male with backache. Re demonstration of intra osseous TB abscesses are seen in lower dorsal vertebrae with peripheral thick enhancing walls seen on T1W post gadolinium images. There is anteriot thecal meningeal enhancement as well.
Fig. 3: Same patient. Lower dorsal vertebral bodies show compression/ collapse with involvement of intervening IV disc, epidural component causing cord compression and edema.
Fig. 4: Same patient, similar T2WI findings as mentioned in fig.3
Fig. 5: Same patient, Marrow replacement lower dorsal vertebrae, hypointense on T1WI. Rest of the vertebrae appear unremarkable.
Case 2:
Fig. 6: Case 2.
23 years old male with history of fall two years back. complains of fever and backache for one month. Compression of D12/L1 vertebrae with angulation deformity and involvement of intervening IV disc.
Another abnormally enhancing area superior endplate of L4.(T1WI)
Fig. 7: Case 2.
23 years old male with history of fall two years back. complains of fever and backache for one month. Compression of D12/L1 vertebrae with angulation deformity and involvement of intervening IV disc.
Another abnormally enhancing area superior endplate of L4.
Fig. 8: Same patient, post contrast coronal T1WI show oblique right paravertebral components with enhancing walls as well.
Fig. 9: Same patient, post contrast T1WI show enhancement of endplates with intraosseous absesses showing peripheral enhancing walls. There are prevertebral components as well.
Fig. 10: Same patient, post contrast axial T1WI show right paravertebral components with enhancing walls as well.
Case 3:
Fig. 11: 26 year old female with bilateral lower limb weakness. T2WI show compression/ collapse of lower dorsal vertebral bodies causing retropulsion in the spinal canal resulting in conal compression
Fig. 12: 26 year old female with bilateral lower limb weakness. T2WI show compression/ collapse of lower dorsal vertebral bodies causing retropulsion in the spinal canal resulting in conal compression
Fig. 13: 26 year old female with bilateral lower limb weakness. Post contrast sagittal T1WI show compression/ collapse with enhancement of lower dorsal vertebral bodies causing retropulsion in the spinal canal resulting in conal compression
Fig. 14: 26 year old female with bilateral lower limb weakness. Coonal T1WI show compression/ collapse of lower dorsal vertebral bodies with bilateral paravertebral components
Case 4:
Fig. 15: T1W hypointense marrow signals with involvement of multiple vertebral bodies in a 15 year old female
Fig. 16: T2W axial images show bilateral paravertebral abscesses, hyperintense on T2W images in a 15 year old female
Fig. 17: T2W hyperintense paravertebral components in a 15 year old female
Fig. 18: T2W hyperintense marrow signals with involvement of multiple vertebral bodies and intervening intervertebral discs in a 15 year old female
Case 5:
Fig. 19: 40 years old labourer with low grade fever and backache.Hypointense L2 vertebral body with involvement of enfacing endplates and epidural components
Fig. 20: 40 years old labourer with low grade fever and backache.Hyperintense L2 vertebral body with involvement of enfacing endplates and epidural components