MRI in intraspinal tuberculosis

Abstract

We studied 20 patients with intraspinal tuberculosis (TB), to characterise the MRI features of tuberculous meningitis and myelitis. MRI leptomeningitis and intramedullary involvement in 11 patients, intramedullary lesions alone in 5, leptomeningitis alone in 2, and isolated extradural disease in 2. TB leptomeningitis was characterised by loculation of the cerebrospinal fluid (CSF), nerve root thickening and clumping (seen only in the lumbar region) or complete obliteration of the subarachnoid space on unenhanced images. Gd-DTPA-enhanced images proved useful in 6 cases, revealing linear enhancement of the surface of the spinal cord and nerve roots or plaque-like enhancement of the dura-arachnoid mater complex. Intramedullary lesions included tuberculomas (8), cord oedema (5) and cavitation (3). In seven cases of intramedullary tuberculoma multiple lesions with skip areas were seen, without significant cord swelling. One patient had an isolated lesion in the conus medullaris. The lesions were iso- or hypointense on T1-weighted images, iso-, hypo- or hyperintense on T2-weighted images and showed rim or nodular enhancement with contrast medium.

Atypical intradural spinal tuberculosis: report of three cases

“…Although the thoracic spine was reported to be the most common site of involvement, tuberculoma or TB abscess may develop anywhere within the thecal sac. 9,[11][12][13] It is usually closely adherent to the inner aspect of the dura and to the cord into which it penetrates like a crater, so in occasional cases it becomes very difficult to define whether the intradural tuberculoma is extramedullary or intramedullary. 13,14 Intramedullary spinal cord abscess is a rare clinical entity and only 83 cases [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] have been reported in the literature since the original case documented by Hart in 1830.…”

Tuberculose intramédullaire. À propos d’un cas

“…L'IRM médullaire est considérée comme l'examen de neuroimagerie de référence (Kioumehr et al, 1994 ;Gupta et al, 1994). L'aspect le plus fréquent est celui d'une grosse moelle en iso-ou léger hyposignal en T 1 , avec rehaussement par injection de gadolinium et hypo-ou isosignal en T 2 .…”

Intramedullary tuberculoma of the conus medullaris: case report and review of the literature

“…Modern neurodiagnostic studies can aid in the localization of the tuberculous process to the extradural, intradural extramedullary, or intramedullary compartment. 7 Although myelography used to be the diagnostic procedure of choice in the evaluation of intramedullary tuberculosis, MRI is clearly superior in sensitivity and speci®city. The advent of MRI may facilitate the diagnosis of an intramedullary mass consistent with tuberculoma.…”

“…The advent of MRI may facilitate the diagnosis of an intramedullary mass consistent with tuberculoma. 7,13 The prognosis for neurologic improvement is good with appropriate therapy. 3,12,14 Medical therapy remains the mainstay of treatment, but when confronted with a progressing neurologic de®cit, surgery may be indicated.…”