Spinal tuberculosis: atypical observations at MR imaging.
OBJECTIVE
To evaluate atypical magnetic resonance (MR) imaging features of spinal tuberculosis.


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 neoplasm than infection. One patient, a European immigrant, had acquired immunodeficiency syndrome (AIDS).


RESULTS
Areas involved with tuberculosis were hypointense on T1-weighted images and hyperintense on T2-weighted images, and became enhanced with gadopentetate dimeglumine. In two patients, tuberculosis affected only a single vertebral body without paraspinal abscesses or involvement of the end plates and disk spaces. In two other patients, only a single spinous process was replaced with tuberculous abscess. In the remaining patient, the sacrum and multiple lower lumbar vertebrae were affected, but the intervertebral disk spaces were not affected. More typical findings of spinal tuberculosis include destruction of two adjacent vertebral bodies and opposing end plates, destruction of intervening disk space, and/or occurrence of paravertebral abscesses.


CONCLUSIONS
Neither clinical examination nor MR findings may be reliable in helping differentiate spinal infections from one another or from neoplasm. Adequate biopsy is essential for early diagnosis and prompt treatment.
Ahmadi
J
J
Department of Radiology, University of Southern California School of Medicine, LAC-USC Medical Center 90033.
Bajaj
A
A
Destian
S
S
Segall
H D
HD
Zee
C S
CS
D000038:Abscess / Q000175:diagnosis; D000328:Adult; D002574:Cervical Vertebrae / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012447:Sacrum / Q000473:pathology; D013122:Spinal Diseases / Q000175:diagnosis; D013125:Spinal Neoplasms / Q000175:diagnosis; D014399:Tuberculosis, Spinal / Q000175:diagnosis*