Purpose. To describe the MR findings in intramedullary tuberculomas and to
discuss the usefulness of MR in the management of this pathology.
Material and Methods: A retrospective study of 7 patients from 21 to 60 yea
rs of age with clinical and radiological evidence of intramedullary tubercu
lomas was undertaken. Both T1- and T2-weighted images (WI) were obtained al
ong with postcontrast T1WI. Signal intensities (SIs) of the granulomas were
compared with SIs of the normal spinal cord.
Results: Six patients showed focus of tuberculosis elsewhere in the body. S
ix out of 7 showed fusiform swelling of the cord. Ill-defined iso-intensity
(in 4 patients) to hyperintensity tin 3 patients) was seen at the site of
granuloma on T1WI. On T2WI, 2 patients revealed a hypointense area with dis
c enhancement). An iso-hypointense rim was seen surrounding a hyperintense
centre in 5 patients (with rim enhancement). Adjacent oedema was seen in al
l patients. In 2 patients meningeal enhancement was also seen. In 2 patient
s the histopathology following surgical biopsy confirmed the diagnosis. In
the remaining 5 patients, another known focus of tuberculosis elsewhere in
the body and a marked response to antitubercular treatment was considered c
onfirmatory for tuberculomas.
Conclusion: Hypo- or iso-intensity on T2WI within the spinal cord with surr
ounding hyperintense oedema is suggestive of intramedullary tuberculomas. C
entral hyperintensities are also detected at times due to a variable amount
of caseous necrosis with liquefaction. On T1WI, fusiform swelling of the c
ord is seen along with iso- to hyperintense foci, surrounded by hypointense
oedema of the cord. Such findings should prompt a contrast-enhanced study,
which may show single or conglomerate disc- or ring-enhancing lesions. MR
thus plays an important role not only in detection and diagnosis, but also
in deciding the treatment options and in the follow-up of those patients.