Magnetic Resonance Imaging, Vol. 14, No. 6, pp. 691-695, 1996 Copyright Q 1996 Elsevier Science Inc. Printed in the USA. All rights reserved 0730-725X/96 $15.00 + .OO ELSEVIER 0 Case Report PI1 SO730-725X( 96) 00093-7 PROTON MRS IN POTT’S SPINE-A CASE REPORT RAMA JAYASUNDAR, * M. GOYAL, t R. SHARMA, “r AND P. RAGHUNATHAN * *Department of NMR, TDepartment of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India Proton Magnetic Resonance Spectroscopy was carried out at 1.5 T on a patient with histologically proven Pott’s spine affecting Dll vertebral body. In addition to the significantly reduced signals from the lipids in the region between 1 and 2 ppm, a prominent resonance at 5.1 ppm is seen. The spectrum is very different from that recorded on the one hand for a normal spine and, on the other, for a tumor arising from the vertebral body of a patient. Keywords: Magnetic Resonance Spectroscopy (MRS) ; Tuberculosis; Spine. INTRODUCTION Tuberculosis of the nervous system continues to be a source of high mortality and morbidity in India and other countries with chronic endemic problems.’ Al- though the usefulness of the imaging modalities in localization of pathology and evaluation of its extent is not a subject of debate, the exact nature of the under- lying etiology is not known in most cases, especially in the early stages of Pott’s spine with no paravertebral abscess or reduced disc space. The potential of Magnetic Resonance Spectroscopy (MRS ) in providing biochemical information is being widely accepted. Reports on in vivo localized proton spectroscopy in the central nervous system, dealing in particular with the brain, are numerous. In contrast, MRS studies on spine are limited.2-6 The current litera- ture shows that MRS in spine has been primarily car- ried out in patients with leukemia and after bone mar- row transplantation.3,4.6 We present a case of ‘H MRS of vertebral body affected by tuberculosis (Pott’s spine). The spectrum has been compared with that obtained from normal healthy volunteers (age and sex matched) and also from a patient with a tumor arising from the vertebral body. MR METHODS The MR studies were performed on a 1.5 Tesla whole-body unit (Siemens, Magnetom) . The body coil was used as the transmitter and a surface coil (spine coil from Siemens) as the receiver. All the studies were carried out with the subjects lying supine with the area of interest positioned over the surface coil. For the clinical investigation, both T2- and Gadolinium- enhanced T,-weighted images were obtained in sagittal and axial planes. The T2 images were obtained using Fast Spin Echo with echo time (TE) of 110 ms, repeti- tion time (TR) of 4200 ms, matrix of 256 x 192 with a rectangular field of view (3:4), slice thickness of 4 mm, and NEX of 1. For the T,-weighted images, TE of 15 ms, TR of 550 ms, and NEX of 3 were used. For spectroscopy, T,-weighted images were ac- quired in three perpendicular planes to demarcate the volume of interest (VOI). Proton spectra were ob- tained from a voxel of 2 X 2 X 2 cm3, from the patients and normal volunteers (n = 4). In the case of the patients, the voxel was positioned within the bound- aries of the lesion. Adequate care was taken to keep the voxel limited to the vertebral body and not include the disc space. For the volunteers, two spectra were obtained, one positioned within the vertebral body and the other including the intervertebral disc. Spectroscopy was carried out using the RF pulse sequence “STEAM,” with an echo time of 135 ms. Other spectral parameters used were: TR of 3 s, 12X acquisitions, and a vector size of 2K points. Prior to actual acquisition, magnetic field shimming was car- ried out to optimise the field homogeneity over the VOI. Typical linewidths obtained were 10 to 20 Hz. RECEIVED 9126195; ACCEPTED 4/I 1196. ment of N.M.R., All India Institute of Medical Sciences, Address correspondence to Dr. Rama Jayasundar, Depart- Ansari Nagar, New Delhi 110029, India. 691