Role of magnetic resonance diffusion imaging and apparent diffusion coefficient values in the evaluation of spinal tuberculosis in Indian patients

Abstract

Aim:To define a range of apparent diffusion coefficient values in spinal tuberculosis and to evaluate the sensitivity of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient values in patients of spinal tuberculosis.Materials and Methods:This study was conducted over a period of 20 months and included 110 patients with a total of 230 vertebral bodies. The study was performed in two parts. The first part included all patients of known tuberculosis and patients with classical features of tuberculosis. The second part included patients with spinal pathology of indeterminate etiology. All the patients underwent a routine MRI examination along with diffusion sequences. The apparent diffusion coefficient (ADC) values were calculated from all the involved vertebral bodies.Results:The mean ADC value of affected vertebrae in first part of the study was found to be 1.4 ± 0.20 × 10−3 mm2/s. This ADC value was then applied to patients in the second part of study in order to determine its ability in predicting tuberculosis. This range of ADC values was significantly different from the mean ADC values of normal vertebrae and those with metastatic involvement. However, there was an overlap of ADC values in a few tuberculous vertebrae with the ADC values in metastatic vertebrae.Conclusion:We found that DW-MRI and ADC values may help in the differentiation of spinal tuberculosis from other lesions of similar appearance. However, an overlap of ADC values was noted with those of metastatic vertebrae. Therefore diffusion imaging and ADC values must always be interpreted in association with clinical history and routine MRI findings and not in isolation.

Pott′s spine: Diagnostic imaging modalities and technology advancements

“…DW-MRI provides information about the composition of tissues, physical properties, and the microstructure of the tissues. [5758] ADC values are a measure of the diffusion ability of molecules which provides the composition of the given tissue. [5758] A high ADC value means increased diffusion of molecules, that is, no restriction, suggesting less compact tissue microstructure.…”

“…[5758] ADC values are a measure of the diffusion ability of molecules which provides the composition of the given tissue. [5758] A high ADC value means increased diffusion of molecules, that is, no restriction, suggesting less compact tissue microstructure. However in TB, an overlap of ADC values can be seen with those of metastatic disease.…”

“…Hence, DW-MRI and ADC values should always be interpreted in association with clinical history and conventional MRI findings. [5758]…”

The value of apparent diffusion coefficient measurements in the differential diagnosis of vertebral bone marrow lesions

“…Central nervous system tuberculosis, basal meningitis, hydrocephalus, edema, ischemia-infarct, abscess, and arachnoiditis may occur in various forms and may show different symptoms (5). Infections can sometimes be difficult to diagnose, especially when there is isolated vertebral body involvement without any soft tissue component, and adjacent disk involvement (6). Therefore, in order to plan appropriate therapy according to the precise diagnosis, the patients are exposed to invasive interventions such as biopsy (2,7,8).…”

How Magnetic Resonance Imaging is Helps in Diagnosis of Tuberculosis of Spine?

“…Meningeal involvement which indicate active inflammation and rim enhancement around intra osseous and para spinal soft tissue abscesses, which are rarely seen in non-tubercular abscesses are best demonstrated on contrast enhanced MRI. [11][12] Four different sites are found to involve in vertebral TB: para discal, anterior, central and posterior lesions. The majority of authors suggest that the onset of the spinal infection is para discal.…”