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PHAM QUANG CO CAO THIEN TUONG PHAM NGOC HOAMAGNETIC RESONACE IMAGING FINDINGS IN SPINAL TUBERCULOSIS... A definite diagnosis of spinal TB is ussually late..  Sequela: Spinal deformity,

PHAM QUANG CO CAO THIEN TUONG PHAM NGOC HOA

MAGNETIC RESONACE IMAGING FINDINGS IN SPINAL TUBERCULOSIS

 Introduction

 Study method

 Results and discussion

 Conclusion and proposal

 Spinal tuberculosis (Spinal TB):

 In 1779, Percival Pott (1714-1788) first described spinal TB.

 The clinical presentations are not pathognomotic A definite diagnosis of spinal TB is ussually late

 Prevalence #2%

 Sequela: Spinal deformity, compression of spinal cord and nerve roots

 Role of radiography, CT scan and other diagnostic

methods in order to diagnosing spinal TB are still limited MRI is a best imaging method for diagnosing spinal TB

Background

 Annually, hundreds of spinal TB patients were admitted at department of rheumatology of

Choray hospital and about 40 patients with

spinal TB were operated at the neurosurgery department of Choray hospital.

 In order to help early diagnosing this disease,

we are performed the subject: “Study of MRI findings in diagnosis of spinal TB at Choray hospital”.

1 Evaluate several epidemiological features.

2 Demonstrate several common MRI findings of spinal TB

Materials and study method

Study design: descriptive cross-sectional study

Sample size: n = 73 cases

Target population : All patients with spinal TB

Selection criteria: 1 of 3 criteria

- BK(+)/succus or pathological evidence of tuberculosis.

- Clinical presentation of spinal TB +

Duration: from 01/7/2006 to 31/6/2008.

neurosurgery – Choray hospital

Methods of data collection:

-Review of medical records

Protocol MRI of spine at Choray hospital

 Sagittal T1W, T2W, STIR, axial T2W, coronal T2W

 Axial, Coronal, Sagittal T1W FS + Gd

-MRI images are interpreted by two radiologist experienced in MRI

Analyse and process data:

 Data is inputed and processed by SPSS 15.0

 Calculate frequency and percentage

Results is represented in the form of

table and graph

RESULTS

and DISCUSSION

Highest 41-60, 39,7% Sinan 30%; Stembach USA children+elder

DISTRIBUTION BY AGE GROUP

Sinan 4/3

DISTRIBUTION BY SEX

Alothman 84% pain, 45% movement disorder; Comican 100%

DISTRIBUTION BY CLINICAL SYMPTOMS

SCIENCE PHOTO LIBRARY

DISTRIBUTION BY LABORATORY TESTS

T1W T2W/STIR T1W FS+ Gd

Isointe nsity

Hypoin tensity

Hyperi ntensit y

Hypoin tensity

Isointe nsity

Ring enhanc ement

Hetero genous enhanc ement

Vertebr

al body 100% 100% 90% 10%Disc 79% 21% 77% 11% 12% 3% 97%

Parasp inal soft tissues

Sinan 90,9%

DISTRIBUTION BY

LESION PATTERNS

ON SPINE

-Thoracic+lumbar 79,5%

-Sinan 79,9%

-Al-Muhin 86%

DISTRIBUTION BY SITE OF LESIONS

Sinan 90,9%; Lindahl 4,76%; Joseffer luu y Metas.

Loke 47% > 2 vertebrae

DISTRIBUTION

BY NUMBER

OF INVOLVED VERTEBRAE

Danchaivijitr hủy hoàn toàn 100-81,4%; Tủy 90,3-76,5%

DISTRIBUTION BY PATTERNS OF VERTEBRAL LESIONS

-Full loss of structure :

Cause: Joseffer Seth S:

absence of proteolytic enzym;

DISTRIBUTION BY NUMBER OF

INVOLVED DISCES

Danchaivijitr compression

of spinal cord and nerve

roots 80,6%

DISTRIBUTION OF SPINAL CORD LESIONS ON MRI

Danchaivijitr 96,8-85,3%

DISTRIBUTION BY ABSCESS OF SOFT TISSUES ON MRI

DISTRIBUTION

BY SITE OF PARASPINAL ABSCESS

EXTENSION

OF ABSCESS FROM

INVOLVED VERTEBRA

CONCLUSION

and PROPOSAL

 MRI is the best imaging method for diagnosing spinal TB.

 Vertebral lesions: continous 93,2%; Thoracic vertebrae 43,8%, lumbar vertebrae 24,7%; Number of involved vertebrae ≥ 3: 46,6%.

 > 98% vertebrae involve both the endplate and vertebral bodies causing vertebral collapse.

 Vertebral lesions on MRI:

100% ↓ signal intensity on T1W, heterogenous hyperintensity on T2W and heterogenous-ring enhancement

 Spinal TB with compression spinal cord 61,6%, fill in bilateral intervertebral foramina and compression nerve roots 94,6%.

 Spinal TB with abscess of soft tissuses 98,6%; bilateral paraspinal soft tissues 93%, > 2 abscess foci 97,2%.

Combined diseases: Diabete 5,4%; pulmonary tuberculosis 4,1%, other tuberculosis 2,8%; immune deficiency 5,4%.

 Far extension of abscesses 64,4%, perivertebral abscess and compression of dural sac or anterior-lateral epidural abscess 97,2%.

 Soft tissue lession on MRI:

-T1: 98,6% ↓ signal + heterogenous-ring enhancement

-T2: 98,6 % ↑ signal

PROPOSAL

clinical presentation, laboratory tests, imaging modalities and pathology.

this is the best imaging method for diagnosis of spinal TB