SPINAL TUBERCULOSIS - ATYPICAL OBSERVATIONS AT MR-IMAGING

PURPOSE: To evaluate atypical magnetic resonance (MR) imaging features of spinal tuberculosis. MATERIALS AND METHODS: Between 1990 and 1993, five of 11 consecutive patients with spinal tuberculosis (two men and three women, aged 30-57 years) had MR findings more suggestive of neo plasm than infection. One patient, a European immigrant, had acquired immunodeficiency syndrome (AIDS). RESULTS: Areas involved with tubercu losis were hypointense on T1-weighted images and hyperintense on T2-we ighted images, and became enhanced with gadopentetate dimeglumine. In two patients, tuberculosis affected only a single vertebral body witho ut paraspinal abscesses or involvement of the end plates and disk spac es. In two other patients, only a single spinous process was replaced with tuberculous abscess. In the remaining patient, the sacrum and mul tiple lower lumbar vertebrae were affected, but the intervertebral dis k spaces were not affected. More typical findings of spinal tuberculos is include destruction of two adjacent vertebral bodies and opposing e nd plates, destruction of intervening disk space, and/or occurrence of paravertebral abscesses. CONCLUSION: Neither clinical examination nor MR findings may be reliable in helping differentiate spinal infection s from one another or from neoplasm. Adequate biopsy is essential for early diagnosis and prompt treatment.