Post on 15-Jan-2017
Imaging Features of Tuberculous Spondylitis
By Dr. Humera Ahsan Department of Radiology Aga Khan University Hospital
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 1 of 62
BACKGROUND •! Approximately 1 – 2% of total tuberculous cases are
attributable to Tuberculosis of the spine. •! According to WHO, more than 8 million new cases of
TB occur each year. Currently 19 – 43.5% world s population is infected with M. tuberculosis.
•! Developing countries including India, China,
Pakistan, Phi l ippines, Thailand, Indonesia, Bangladesh and the Democratic Republic of Congo account for nearly 75% of all cases of TB.
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 2 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 3 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 4 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 5 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 6 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 7 of 62
The purpose of study is to determine the imaging
features of tuberculous spondylitis.
OBJECTIVE
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 8 of 62
INTRODUCTION •! Tuberculous spondylitis is defined as an infection by
Mycobacterium tuberculosis of one or more components of the spine: vertebra, intervertebral disc, paraspinal soft tissue or extradural space.
•! The infection begins in the anterior part of vertebral
body, adjacent to the endplate. •! With disease progression intervertebral disc becomes
involved with subsequent loss in disc height.
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 9 of 62
INTRODUCTION
•! Disease progression leads to vertebral collapse and anterior wedging leading to angulation and characteristic gibbous deformity.
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 10 of 62
METHODOLOGY •! MRI of 51 patients with tuberculous infection of the spine
at the Aga Khan University Hospital for a period of 2 ! years from January 21, 2002 till June 1, 2004 were retrospectively reviewed by two expert radiologists.
•! After review of the medical records by another author 11
(21.5%) of the cases were excluded because M. tuberculosis could not be identified and the features were attributed to other pyogenic organisms.
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 11 of 62
METHODOLOGY •! The reviewer while examining the medical records
looked for the absence or presence of characteristic features of tuberculous spondylitis such as
•! a. Osseous involvement of the vertebrae •! b. Site of lesion c. Number of vertebrae involved •! d. Involvement of anterior or posterior elements or
endplates •! e. Gibbous deformity •! f. Epidural or paraspinal abscess and •! g. Involvement of the interverteberal disc
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 12 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 13 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 14 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 15 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 16 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 17 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 18 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 19 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 20 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 21 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 22 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 23 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 24 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 25 of 62
RESULTS
•! There were 10 (25%) cases that had formation of gibbous deformity.
•! 6 (15%) of the cases had evidence of epidural
abscess where as 9 (22.5%) had evidence of paraspinal abscess.
•! There was resolution of tuberculosis on anti-
tuberculous therapy in 9 (22.5%) cases.
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 26 of 62
CONCLUSION
•! There was a high incidence of gibbous deformity observed.
•! The paraspinal abscess was more common than epidural abscess.
•! The percentage of osteomyelitis was significantly higher.
•! The site of lesion mainly centered in the mid and lower lumbar vertebrae.
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 27 of 62
LESIONS OF CERVICAL SPIN
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 28 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 29 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 30 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 31 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 32 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 33 of 62
LESIONS INVOLVING DORSAL SPINE
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 34 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 35 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 36 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 37 of 62
LESIONS OF THE LUMBAR SPINE
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 38 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 39 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 40 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 41 of 62
PEDIATRIC CASE
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 42 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 43 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 44 of 62
UNUSUAL SITES OF INVOLVEMENT
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 45 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 46 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 47 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 48 of 62
EARLY DISEASE
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 49 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 50 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 51 of 62
SCAN ONE MONTH LATER
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 52 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 53 of 62
MULTICENTRIC INVOLVEMENT
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 54 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 55 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 56 of 62
SURGICAL TREATMENT
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 57 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 58 of 62
SPARED INTERVERTEBRAL DISC
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 59 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 60 of 62
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 61 of 62
REFERENCE
1.! The Encyclopaedia of Medical Imaging Volume VII. (http://www.amershamhealth.com/medcyclopaedia/medial/volume%20vii/tuberculous%20spondylitis.asp.)
2.! Emedicine (http://www.emedicine.come/med/topic1902.htm)
3.! Emedicine (http://www.emedicine.com/PED/topic2321.htm)
Presentation material is for education purposes only. All rights reserved. ©2004 URMC Radiology Page 62 of 62