MRI findings in proven Mycobacterium tuberculosis (TB) spondylitis

Kotze, D.J.; Erasmus, L.J.

doi:10.4102/sajr.v10i2.176

Cited by 7 publications

(8 citation statements)

References 7 publications

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“…Many reports published to date indicate sparing of intervertebral discs in tuberculous spondylitis [ 23 , 24 , 31 , 32 ], which was linked to the fact that mycobacteria do not produce proteolytic enzymes. In our study intervertebral disc destruction was similar in both types of inflammation, which might be due to longer disease duration before MR imaging.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging in Differentatial Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis

et al. 2018

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SummaryBackgroundInfectious spondylodiscitis is characterized by the involvement of two adjacent vertebrae and the intervening disc. Incidence rate of the disease is estimated at 0.4–2 cases per 100000 per year. Staphylococcus aureus is the most common infectious agent causing pyogenic spondylodiscitis. Non-pyogenic infections of the spine are most frequently caused by Mycobacterium tuberculosis, and fungi. Clinical symptoms are nonspecific. Early diagnosis and appropriate treatment can prevent unfavorable irreversible sequela for the patient.Significant developments in techniques of imaging of pathological tissues raised expectations among the clinicians regarding possibility to distinguish between tuberculous spondylodiscitis and pyogenic spondylodiscitis on MR images. The aim of this study was to identify and differentiate between features of tuberculous and pyogenic spondylodiscitis on MR images.Material/MethodsWe performed retrospective analysis of MR images obtained from 34 patients with confirmed spondylodiscitis (18 with pyogenic spondylodiscitis, and 16 with tuberculous spondylodiscitis). Data acquisition was performed using 1.5 T MRI scanners where images were obtained using similar protocols. T2 TIRM and T1-weighted images with and without contrast enhancement were subject to assessment in coronal, axial and sagittal planes.ResultsCharacteristic features of pyogenic spondylodiscitis include: involvement of the lumbar spine, ill-defined paraspinal abnormal contrast enhancement, diffuse/homogeneous contrast enhancement of vertebral bodies, low-grade destruction of vertebral bodies, hyperintense/homogeneous signal from the vertebral bodies on T2 TIRM images. Prevailing features of tuberculous spondylodiscitis included: involvement of the thoracic spine, involvement of 2 or more adjacent vertebral bodies, severe destruction of the vertebral body, focal/heterogeneous contrast enhancement of vertebral bodies, heterogeneous signal from the vertebral bodies on T2 TIRM images, well-defined paraspinal abnormal contrast enhancement, paraspinal and epidural abscesses, meningeal enhancement at the affected spine level.ConclusionsComparison of MR images of patients diagnosed with pyogenic spondylodiscitis and tuberculous spondylodiscitis allowed identification of individual characteristics for preliminary differentiation between TB and infectious spondylodiscitis and thereby enabling proper treatment.

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Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging in Differentatial Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis

et al. 2018

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“…With the aid of intravenous administration of magnetic resonance contrast agents, MRI was highly accurate in distinguishing granulation tissue from cold abscess. [303132] MRI can reveal more extensive involvement than the plain films. [253334] MRI provided more exact anatomic localization of vertebral and paravertebral abscesses in multiple planes not previously available with more conventional diagnostic methods in the patients with suspected TB spondylitis.…”

Section: Imagingmentioning

confidence: 99%

“…[833] Both CT and MRI are extremely helpful for diagnosis, and tissue aspirate is a good confirmatory method. [20313738]…”

Section: Imagingmentioning

confidence: 99%

Pott′s spine: Diagnostic imaging modalities and technology advancements

et al. 2013

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Spinal tuberculosis (TB) or Pott's spine is the commonest extrapulmonary manifestation of TB. It spreads through hematogenous route. Clinically, it presents with constitutional symptoms, back pain, tenderness, paraplegia or paraparesis, and kyphotic or scoliotic deformities. Pott's spine accounts for 2% of all cases of TB, 15% of extrapulmonary, and 50% of skeletal TB. The paradiscal, central, anterior subligamentous, and neural arch are the common vertebral lesions. Thoracic vertebrae are commonly affected followed by lumbar and cervical vertebrae. Plain radiographs are usually the initial investigation in spinal TB. For a radiolucent lesion to be apparent on a plain radiograph there should be 30% of bone mineral loss. Computed tomographic scanning provides much better bony detail of irregular lytic lesions, sclerosis, disc collapse, and disruption of bone circumference than plain radiograph. Magnetic resonance imaging (MRI) is the best diagnostic modality for Pott's spine and is more sensitive than other modalities. MRI frequently demonstrates disc collapse/destruction, cold abscess, vertebral wedging/collapse, marrow edema, and spinal deformities. Ultrasound and computed tomographic guided needle aspiration or biopsy is the technique for early histopathological diagnosis. Recently, the coexistence of human immunodeficiency virus infections and TB has been increased globally. In recent years, diffusion-weighted MRI (DW-MRI) and apparent diffusion coefficient values in combination with MRI are used to some extent in the diagnosis of spinal TB. We have reviewed related literature through internet. The terms searched on Google scholar and PubMed are TB, extrapulmonary TB, skeletal TB, spinal TB, Pott's spine, Pott's paraplegia, MRI, and computed tomography (CT).

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“…Epidural abscess formation (figure 2) results in narrowing of the spinal canal diameter with resultant cord compression and neurological deficits. 5 In the present study, we have attempted to depict the various spectrum of presentations of spinal TB with clinical correlation.…”

Section: Discussionmentioning

confidence: 99%

“…10 Shanley DJ 6 evaluated radiographic manifestations of tubercular spondylitis like intraosseous and paraspinal abscess formation as seen in our study mentioned in Figure 4 & 6 and Figure 8, paraspinal abscesses in the lumbar region gravitate along the psoas sheath which can extend to the femoral region and cause erosion of overlying skin. 5,6 MRI is the gold standard of imaging in TB Spondylitis due to its superior soft tissue resolution and multiplanar capability. The classic pattern of spread starting anteriorly and moving to involve opposing vertebrae via subligamentous spread is clearly seen on MRI.…”

Section: Discussionmentioning

confidence: 99%