This document discusses the radiographic findings of spinal tuberculosis. It notes that spinal tuberculosis most commonly involves the thoracic and lumbar spine, beginning in the anterior vertebral body. Plain radiographs may show focal erosion and destruction, while CT is superior for evaluating bony destruction. MRI is highly sensitive for detecting soft tissue and spinal involvement, and contrast-enhanced MRI can distinguish tuberculous lesions from other granulomatous diseases by thick rim enhancement of paraspinal and intraosseous abscesses. Differences from metastatic involvement include breached disc spaces and minimal periosteal reaction and sclerosis with tuberculosis.

1. NEURORADIOLOGY IN
SPINAL
TUBERCULOSIS
Dr. Nishtha jain
Senior resident,
Departtment of neurology,
GMC, kota.

2. Spinal tuberculosis
 The most common form of skeletal
involvement in TB.
 Spinal infection is usually the result of
hematogenous seeding of the vertebral body.
 The diagnosis often remains elusive because
of the indolent nature of tuberculous infection.

3.  Mostly involves thoracic and the lumbar spine.
 Usually begins in the anterior aspect of the
vertebral body.
 Adjacent to the vertebral endplate.

4. Radiographic manifestations
 Intraosseous and paraspinal abscess
formation.
 subligamentous spread of infection.
 vertebral body destruction and collapse
resulting in significant instability and deformity
of the spine.
 extension into the spinal epidural space.

5. Plain radiograph
 Focal areas of
erosion and
osseous destruction
in the anterior
corners of the
vertebral body are
typical plain film
findings.

6. Plain radiograph
 Contiguous
vertebral body
involvement
 Destruction of the
intervertebral disk
 Progerssive
vertebral collapse

7. Plain Radiograph
 Compression
fracture and
secondary
osteosclerosis

8. Plain radiograph
 Paraspinal abcess
formation may be
detected as areas of
fusiform soft tissue
swelling around the
spine

9. Plain radiograph
 Central lucency with
surrounding
sclerosis suggestive
of chronic infection.

10. Scintigraphy
 Initially bone scans and gallium studies can be
negative despite active disease.
 Later on increased bony metabolism manifests as
increased radionuclide uptake.
 Useful in determining the number of active sites of
the disease.
 Helpful in determining the involvement of posterior
elements of the spine.
 Also useful in chronic infection in monitor the
response to therapy.

11. scintigraphy
 Posterior view from
whole body bone
scan showing
increased
radionuclide uptake
in middle and lower
thoracic spine

12.  SPECT scans
showing
involvement of
vertebral bodies and
extension into
posterior elements

13.  As tubercular
lesions demonstrate
high 18F-FDG
uptake, 18F-FDG
PET/CT is a
promising technique
for the diagnosis of
spinal infection

14. CT findings
 Anterior vertebral
body destruction

15. CT findings
 Vertebral body
collapse
 Disk space
narrowing
 Large paraspinal
soft tissue masses
representing abcess
formation

16. CT findings
 Cloaca formation
may be visualised
resulting from
spontaneous
decomprssion of the
vertebral body
abcess

17. CT findings
 Large abcess in left
psoas muscle
attributable to
spontaneous
decompression of
the T12
intraosseous abcess

18. CT findings
 CT scan through
lower part of the
chest showing large
left pleural effusion
with atelectasis due
to cephalic
extension of the
paraspinal abcess
and rupture into left
pleural cavity.

19. CT findings
 In chronic stages
there is marked
bone destruction
with sequestrum
formation

20. Myelographic findings
 Plain myelography
findings include
displacement or
thinning of the
column of contrast
material because of
the mass effect.

21. Myelographic findings
 CT myelography is
useful for determinig
the extent of
epidural process
and differentiating
the epidural abcess
from the bony
encroachment on
the spinal canal.

22. Myelographic findings
 CT myegraphy also
provides additional
anatomic
information including
unsuspected
paraspinal masses.

23. MR findings
 Highly sensitive and specific for spinal
tuberculosis
 Provides early detection
 Best to know extent of soft tissue and spinal
involvement
 CT is superior to MRI in the evaluation of the
degree of bony destruction, deformity and
calcification.

24. MR findings
 T1 images typically
show decreased
signal within the
affected vertebral
bodies, loss of disk
height and
paraspinal soft
tissue masses

25. MR findings
 T2 images show
non specific
increased signal
intensity within
areas of osseous
and soft tissue
changes.
 Extent of paraspinal
abcess formation
anteriorly is better
visualised.

26. MR findings
 Contrast enhanced
sequences are helpful
in distinguishing
tuberculous lesions
from other
granulomatous
diseases.
 The presence of thick
rim of enhancement
around the paraspinal
and intraosseous
abcesses is found to
be diagnostic of
spinal tuberculosis.

27.  T2-weighted
magnetic resonance
image of the
thoracic spinal cord
of a patient with 2
hyperintense
intramedullary
tuberculomas.

28.  T1-weighted
gadolinium-enhanced
magnetic resonance
image of the thoracic
spinal cord in a patient
with acquired
immunodeficiency
syndrome (AIDS) and
leptomeningeal
tuberculosis. Note the
numerous granulomas
on the dorsal surface of
the cord and the dural
enhancement

29. MR in HIV positive patients
 In HIV positive patients, the incidence of skeletal
TB is 60%.
 Destruction of vertebrae with resultant kyphosis is
less in HIV positive patients than in HIV negative
patients; however the site, pattern, and volume of
abscess formation are same in both groups.
 There is greater epidural pus formation in the HIV
positive group.
 In HIV patients the less vertebral body
destruction is thought to be due to disruption of
type 4 hypersensitivity reaction causing
granulomatous inflammation.

30. Differences from metastatic
involvement
 A breached disc space with involvement of two
contiguous vertebral bodies is one of the
features that differentiates infectious from
neoplastic involvement
 Multiplicity in neoplastic involvement
 Involvement of anteroinferior part in tubercular
involvement
 minimal periosteal reaction and sclerosis with
TB

31.  MR imaging findings suggestive of acute
osteoporotic compression fractures
 a low-signal-intensity band on T1- and T2-
weighted images
 spared normal bone marrow signal intensity of
the vertebral body
 retropulsion of a posterior bone fragment
 multiple compression fractures

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