Diagnostic Accuracy of MR Imaging in Tuberculous Spondylitis
Nasuda Danchaivijitr MD*, Siriwan Temram MD*, Kullathorn Thepmongkhol MD*, MSc*, Pipat Chiewvit MD*
Affiliation : * Department of Radiology, Siriraj Hospital, Mahidol University
Objective : To systemically evaluate MR imaging features of tuberculous spondylitis and to find features that
may help differentiating tuberculosis from other spinal diseases.
Materials and Methods : Retrospective review of 65 MR imaging of two groups of patients between January
2002 and December 2005. Thirty-one patients were diagnosed as tuberculosis spondylitis and the rest were a
randomly selected group of 34 patients with other spinal diseases. All images were reviewed by two
neuroradiologists blinded to clinical data. Sensitivity and specificity of each MR imaging features were
calculated.
Results : Three most useful MR imaging features with high sensitivity and specificity (> 80%) were endplate
disruption (100%, 81.4%), paravertebral soft tissue (96.8%, 85.3%), and high signal intensity of intervertebral
disc on T2W (80.6%, 82.4%). High sensitivity but low specificity signs in MRI included bone marrow edema
(90.3%, 76.5%), bone marrow enhancement (100%, 42.5%), posterior element involvement (93.5%, 76.5%),
canal stenosis (87.1%, 26.5%), and spinal cord or nerve root compression (80.6%, 38.2%). Low sensitivity
but high specificity features in MRI were intervertebral disc enhancement (63.3%, 84.2%), vertebral collapse
(58.1%, 85.3%), and kyphosis deformity (67.7%, 82.4%). Overall, the sensitivity and specificity of MRI for
spinal tuberculosis were 100% and 88.2% respectively.
Conclusion : The authors presented three good to excellent sensitivity and specificity MR imaging features for
spinal tuberculosis, end plate disruption, paravertebral soft tissue formation, and high signal of intervertebral
disc on T2W. In contrast to a previous study, most of the presented cases still presented with classic radiological
pictures of “two vertebral disease with the destruction of the intervertebral disc”. Only a small portion of the
patients revealed sparing intervening disc or isolated single vertebral body involvement, which possibly
reflected the early stages of the disease process.
Keywords : Tuberculosis, Spondylitis, Magnetic resonance imaging
