EARLY DIAGNOSIS OF SPINAL TUBERCULOSIS BY MRI

MRI was performed at three centres in Bombay on 24 patients clinically suspected of tuberculosis of the spine but with normal radiographs. T here were 11 males and 13 females and their average age was 24 years ( 11 to 60). Tc-99m bone scans were done in 16 patients before MRI. Elev en patients had the diagnosis confirmed by biopsy and the remainder ah responded rapidly to specific antituberculous chemotherapy. On T1-wei ghted images there was a decrease in signal intensity of the involved bone and soft tissues; on T2-weighted images there was increased signa l intensity. Depending on the stage of the disease, three different pa tterns of infection were revealed: osteitis, osteitis with an abscess, and osteitis with or without an abscess plus discitis. The anatomical pattern of involvement, particularly of the soft tissues and the disc s, is specific for tuberculous disease. The ability of MRI to detect t uberculosis of the spine earlier than other techniques could reduce bo ne destruction and deformity and diminish the need for surgical interv ention. Despite the specificity of the patterns revealed by MRI, biops y is recommended during the stage of osteitis to confirm the diagnosis .