IMAGING OF SPINAL TUBERCULOSIS

1. DR ABHIJIT R SINGH
RESIDENT RADIOLOGY DEPT
IMAGING OF
TUBERCULAR SPONDYLITIS

2. ETIOLOGY OF SPINAL INFECTION
• Staphylococcus Aureus (Most Common; 60%)
• Mycobacterium Tuberculosis (Pott Disease)
• Streptococcus Viridans (IVDU, Immunocompromised)
• Gram-negative Organisms, . Enterobacter Spp., E. Coli
• Less Common Organisms
• Fungal
• Cryptococcus Neoformans,
• Candida Spp.
• Histoplasma Capsulatum
• Burkholderia Pseudomallei (aka. Melioidosis): Diabetic Patients From Southeast
Asia like INDIA and North Australia

3. INTRODUCTION
• Causative org : Mycobacterium tuberculosis.
• Tubercular Spondylitis Was As Old As Egyptians Mummies Some 3000 Yrs Ago.
• 1st Paper Describing The Disease Was Written By PERCIVAL POTT In 1779,hence
known as Potts disease.
• It spreads by haematological route to spine vertebra body [LUMBAR(L1) >THORACIC]
25 to 60% mostly by venous plexus of BATSONs .
• Neural arch and vertebral involvement is rare, but seen in tropical patient
• SUBCHONDRAL ANTERIOR VERTEBRAL ENDPLATE is the earliest focus of infection
in spine.
• The earliest radiographic sign is DISC SPACE NARROWING

4. BLOOD SUPPLY OF VERTEBRA
Azygous
vein
Lumbar
vein
iv
c

6. RADIOLOGICAL IMAGING OF POTTS SPINE
1)X-ray: Preliminary And Imp
2)CT Scan
3)MRI : Gold Standard
4)Radio-Nucleide Scan
5)USG For Abscess Drainage

7. X RAYS FINDINGS IN TUBERCULAR
SPONDYLITIS
Spread of infection is typically subligamentous(ALL) and anterior to vert body
Ivory
vertebra

11. Delineation and Localisation of
Different types of abscess
1)Cervical
2)Thoracic
3)Lumbar

15. T1
COLLECTIONS SEEN IN B/L PSOAS, ANT,POST TO SPONDYLODISKITIS AT
T11 TO L2,ERE SPIN,QUAD LUMBORUM S/O COLD ABSCESS
T1
low signal in disc space (fluid)
low signal in adjacent
endplates (bone marrow
edema)

16. T2W
COLLECTIONS SEEN IN B/L PSOAS, ANT,POST TO SPONDYLODISKITIS AT
T11 TO L2,ERE SPIN,QUAD LUMBORUM S/O COLD ABSCESS
T2: ()
high signal in disc space (fluid)
high signal in adjacent endplates (bone
marrow edema)
loss of low signal cortex at endplates
high signal in paravertebral soft
tissues
hyperintensity within the psoas
muscle (imaging psoas sign): this
finding is ~92% sensitive and ~92%

17. T1C FATSAT
COLLECTIONS SEEN
IN B/L PSOAS,
ANT,POST TO
T11 TO L2,ERE
SPIN,QUAD
LUMBORUM WITH
RING
ENHANCEMENT S/O
COLD ABSCESS
T1 C+ (Gd)
peripheral enhancement around fluid collection(s)
enhancement of vertebral endplates
enhancement of paravertebral soft tissues
enhancement around low-density center indicates
abscess formation

18. • MRI CHARACTERISTICS IN TUBERCULAR SPONDYLITIS
• MRI is the imaging modality of choice due to its very high sensitivity and specificity.
• It is also useful in differentiating between pyogenic, tuberculous, and fungal infections, and a neoplastic process.
• Signal characteristics include:
• T1
• low signal in disc space (fluid)
• low signal in adjacent endplates (bone marrow edema)
• T2: (fat saturated or STIR especially useful)
• high signal in disc space (fluid)
• high signal in adjacent endplates (bone marrow edema)
• loss of low signal cortex at endplates
• high signal in paravertebral soft tissues
• hyperintensity within the psoas muscle (imaging psoas sign ): this finding is ~92% sensitive and ~92% specific for spondylodiskitis
• T1 C+ (Gd)
• peripheral enhancement around fluid collection(s)
• enhancement of vertebral endplates
• enhancement of paravertebral soft tissues
• enhancement around low-density center indicates abscess formation (hard to distinguish inflammatory phlegmon from abscess without contrast)
• DWI
• hyperintense in the acute stage
• hypointense in the chronic stage
• The DWI sequence can help to distinguish between the acute(facilitated) and chronic stages(restricted) of the disease .

19. BASED UPON VERTEBRAL LESION LOCATION,
MRI DISTINGUISHES

20. BASED UPON LESION LOCATION THEY ARE
CLASSIFIED AS

24. DIFFERENTIAL DIAGNOSIS

31. COMPLICATION OF SPINAL TB
• 1)Paraplegia (Potts Disease)
• 2)Cold Abscess
• 3)Spinal deformity
• 4)Sinus tracts
• 5)Secondary Infections

35. THANK YOU ALL
• KEEP SAFE IN CORONA PANDEMIC