Jebmh.com Original Research Article J. Evid. Based Med. Healthc., pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 4/Issue 27/April 03, 2017 Page 1615 MRI IN TUBERCULAR SPINE- TELESCOPING THE EVIL Geetika Sindhwani 1 , Anmita Malik 2 , Ranjan Chandra 3 , Abhinav Jain 4 1 Assistant Professor, Department of Radiodiagnosis, Shree Krishna Hospital, Karamsad, Anand, Gujarat. 2 Professor and Consultant, Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi. 3 Professor and Consultant, Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi. 4 Final Year Student, Department of Urology, Muljibhai Patel Urological Institute, Nadiad, Gujarat. ABSTRACT BACKGROUND Magnetic Resonance Imaging (MRI) is a non-invasive and highly sensitive modality capable of mutliplanar imaging. It helps us to diagnose tubercular spondylitis, where plain radiographs are normal with added advantage of detecting extramedullary tuberculosis, arachnoiditis and intramedullary tuberculosis. MATERIALS AND METHODS MRI Spine was done in 60 clinically and radiographically suspected cases of spinal tuberculosis to establish diagnosis and evaluate extent and neural involvement. Statistical analysis was done using percentages and proportions. RESULTS On MR imaging, a total of 195 vertebrae were found to be involved. The number of vertebral involvement range from 1 to maximum of 10. Contiguous vertebral involvement was seen in 86.67%. Single vertebral involvement was noted in 13.33% patients and 6.67% patients showed skip lesions. Out of 82 involved intervertebral discs, 34.14% discs showed total collapse, 31.4% (26/28) showed partial collapse and 31.14% (28/82) showed intact disc height. 83.33% had paraspinal abscesses on MR imaging. Spinal cord compression was seen in 34 (56.7%) patients, out of which 27/34(79.4%) patients had spinal cord signal alteration. Meningeal involvement and intramedullary granuloma were seen in 1/60 patients. CONCLUSION This study highlights the contribution of MRI in early identification, exact extent of disease, non-radiographically accessible lesions and in atypical presentations like isolated posterior element involvement. KEYWORDS MRI Spine, Tuberculosis, Pott’s Spine. HOW TO CITE THIS ARTICLE: Sindhwani G, Malik A, Chandra R, et al. MRI in tubercular spine- Telescoping the evil. J. Evid. Based Med. Healthc. 2017; 4(27), 1615-1622. DOI: 10.18410/jebmh/2017/316 BACKGROUND Since the earliest days of history, tuberculosis has ravaged the human race with its protean forms, diverse complications and enormous morbidity and mortality. The primary focus of disease is usually visceral (lungs, lymph nodes and gastrointestinal tract). 1 Of the extra pulmonary sites, skeletal tuberculosis constitutes a major segment. Within the osseous form, the most common site is vertebral column, which accounts for 50% of patients with skeletal tuberculosis. 2 The disease occurs with equal frequency in both the sexes. 3 Most common sites of involvement are thoracic and thoracolumbar spine. The commonest radiological presentation involves destruction adjacent to the endplates of two or more vertebral bodies (Paradiscal type). Other common patterns of involvement are Anterior/ Subligamentous, Central type and Neural arch involvement. Atypical presentations include circumferential involvement, lateral vertebral translation and involvement of single or multiple vertebrae. Immunocompromised patients present with more extensive involvement, multiple contiguous vertebral involvement and poor treatment response. Effective imaging evaluation of spine demands not only the capacity to visualise complex bony structure of the vertebral column but also ability to visualise spinal cord, exiting nerve roots and thecal sac that are surrounded and protected by bony canal. 4 Many imaging techniques have been applied to spine starting with plain radiographs, CT to MRI. 5 Radiographic findings manifest late, requiring minimum of 50% destruction of trabecular bone. 3 CT provides higher contrast resolution which allows superb details of bony elements and clearly outlines soft tissue/fat planes. 6 Due to difficulty in differentiating spinal cord from surrounding structures on CT, in cases of narrow subarachnoid space, MRI is investigation of choice now-a-days. 4,5 MR imaging is able to detect changes in vertebral marrow, intervertebral Financial or Other, Competing Interest: None. Submission 09-03-2017, Peer Review 16-03-2017, Acceptance 28-03-2017, Published 03-04-2017. Corresponding Author: Dr. Geetika Sindhwani, Flat 12, Pocket E1, Sector 7, Rohini-110085. E-mail: geetu23130@yahoo.com DOI: 10.18410/jebmh/2017/316