Imaging features of musculoskeletal tuberculosis

Abstract

The purpose of this article is to review the imaging characteristics of musculoskeletal tuberculosis. Skeletal tuberculosis represents one-third of all cases of tuberculosis occurring in extrapulmonary sites. Hematogenous spread from a distant focus elsewhere in the body is the cornerstone in the understanding of imaging features of musculoskeletal tuberculosis. The most common presentations are tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue involvement. The diagnostic value of the different imaging techniques, which include conventional radiography, CT, and MR imaging, are emphasized. Whereas conventional radiography is the mainstay in the diagnosis of tuberculous arthritis and osteomyelitis, MR imaging may detect associated bone marrow and soft tissue abnormalities. MR imaging is generally accepted as the imaging modality of choice for diagnosis, demonstration of the extent of the disease of tuberculous spondylitis, and soft tissue tuberculosis. Moreover, it may be very helpful in the differential diagnosis with pyogenic spondylodiscitis, as it may easily demonstrate anterior corner destruction, the relative preservation of the intervertebral disk, multilevel involvement with or without skip lesions, and a large soft tissue abscess, as these are all arguments in favor of a tuberculous spondylitis. On the other hand, CT is still superior in the demonstration of calcifications, which are found in chronic tuberculous abscesses.

Imaging findings of Pott’s disease

“…Musculoskeletal involvement of TB is estimated in 1-13 % of patients and spine is affected in more than 50 % of cases [2][3][4][5][6][7][8][9]. It is most prevalent in adults with no sex predominance [10][11][12].…”

“…Definitive diagnosis is often difficult because its clinical presentation is indistinct and nonspecific [9,20,21]. Longstanding back pain and constitutional symptoms predominate [2].…”

“…Further the infection spreads within the vertebral body, to the opposite endplate, to the disk space (spondylodiskitis), to the vertebral arch, and beneath the anterior or posterior longitudinal ligaments, leading to extension of the infection to multiple adjacent or separate vertebral segments (Fig. 2) [1,4,8,9,23].…”

The role of polymerase chain reaction in the management of osteoarticular tuberculosis

“…The diagnosis of skeletal tuberculosis is often delayed due to the indolent nature of the disease and, often, it can be elusive, necessitating a high degree of suspicion [8,10,22]. Clinical and radiological diagnosis of musculoskeletal tuberculosis are not adequately sensitive or specific, as there are many differential diagnoses for the radiological findings [6]. Conventional microbiological methods like Ziehl-Neelson staining (Z-N smear) for acid fast bacilli (AFB) and culture of Mycobacterium tuberculosis on Lowenstein Jensen media (L-J) have much lower sensitivity and specificity because of the paucibacillary nature of extrapulmonary tuberculosis [10,24].…”

Rare, chronic monoarthritis of elbow: a case of tuberculosis

“…[7,10,11] Sonuçta eklem hareketleri k›s›tlan›r, kas atrofisi, kontraktürler ve eklemde ankiloz ortaya ç›kar. [12] Radyolojik de¤iflikliklerin ortaya ç›kmas› yavaflt›r ve bu de¤iflliklikler hastal›¤a spesifik de¤ildir. Tbc tan›s›n›n histopatolojik olarak desteklenmesi gerekir.…”