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Original Article
4 (
2
); 122-128
doi:
10.4103/0976-3147.112733

Novel magnetic resonance imaging scoring system for diagnosis of spinal tuberculosis: A preliminary report

Departments of Neurosurgery, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, India
Departments of Radiology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, India
Address for correspondence: Dr. Rajesh Alugolu Department of Neurosurgery, Nizam�s Institute of Medical Sciences Punjagutta, Hyderabad - 500 082 India drarajesh1306@gmail.com
Licence
This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers Private Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

ABSTRACT

Background: There exists a lot of ambiguity in the preoperative diagnosis of the various vertebral lesions. Mostly in thesepatients tuberculosis of spine (TB) is suspected due to endemicity of the disease in the Indian subcontinent. However, nodefinite guidelines are available to diagnose tuberculous (TB) vertebral lesions in the current literature. Study Design: Thisprospective study was conducted in the Department of Neurosurgery, Nizam’s Institute of Medical Sciences, from August2009 to March 2012. Aim of the Study: To formulate non invasive methods to diagnose tuberculous vertebral lesionsconfidently so that the dependency on histopathologic diagnosis can be reduced. Material and Methods: Spinal MRIimages of 45 patients suspected of having tuberculosis aetiology were included in the study prospectively. Results: A totalof 64 patients were analysed and 19 patients were excluded due to lack of regular follow up or histological proof. The patientswere divided into two groups; those with TB of the spine and those with some other condition affecting the spine (nonTB spine) based on the final diagnosis. Of the 45 patients males were 30 (66.6%) and females were 15 (33.3%). There wasno significant difference in the mean age of presentation. For TB patients this was 41 ± 15.56 years and in Non TB was43 ± 18.27 years. All patients presented with backache in either group. There was epiphyseal involvement (100%), discheight reduction (71.42%) and pedicle destruction (42.82%) in plain X‑rays in the TB group. Lumbar spine was the mostcommon affected region in our study (26.31% in non TB and 34.6% in TB group of patients). Significant P value and the OddsRatio was found for T1 hypo intensity, T2 hyper intensity, epiphyseal involvement, disc involvement, pedicle involvement,anterior subligamentous extension, paraspinal extension and no spinous process involvement (eight parameters). Theeight parameters were tested among both the groups and it was noted that scores ≥ 6 favored a tuberculous pathologywhereas ≤4 were suggestive of non tuberculous etiology. Conclusions: The eight point MRI criteria of the vertebrallesions are likely to enhance the diagnostic ability of tuberculous and non tuberculous pathologies thereby reducing thedependency on histopathologic diagnosis or invasive method for early initiation of therapy.

Keywords

Diagnostic criteria
magnetic resonance imaging
scoring system
spinal tuberculosis

Conflict of Interest

None declared

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