TUBERCULAR SPONDYLITIS IMAGING BY DR ABHIJIT SINGH

IMAGING OF SPINAL TUBERCULOSIS

1. DR ABHIJIT R SINGH RESIDENT RADIOLOGY DEPT IMAGING OF TUBERCULAR SPONDYLITIS

2. Etiology of spinal infection Staphylococcus Aureus (Most Common; 60%) Mycobacterium Tuberculosis ( Pott Disease ) Streptococcus Viridans (IVDU, Immunocompromised) Gram-negative Organisms, . Enterobacter Spp., E. Coli Less Common Organisms Fungal Cryptococcus Neoformans, Candida Spp. Histoplasma Capsulatum Burkholderia Pseudomallei (aka.  Melioidosis ): Diabetic Patients From Southeast Asia like INDIA and North Australia

3. INTRODUCTION Causative org : Mycobacterium tuberculosis. Tubercular Spondylitis Was As Old As Egyptians Mummies Some 3000 Yrs Ago. 1 st Paper Describing The Disease Was Written By PERCIVAL POTT In 1779 ,hence known as Potts disease. It spreads by haematological route to spine vertebra body [LUMBAR(L1) >THORACIC] 25 to 60% mostly by venous plexus of BATSONs . Neural arch and vertebral involvement is rare, but seen in tropical patient SUBCHONDRAL ANTERIOR VERTEBRAL ENDPLATE is the earliest focus of infection in spine. The earliest radiographic sign is DISC SPACE NARROWING

4. Blood supply of vertebra Azygous vein Lumbar vein ivc

5. RADIOLOGICAL IMAGING OF POTTS SPINE 1)X-ray: Preliminary And Imp 2)CT Scan 3)MRI : Gold Standard 4)Radio- Nucleide Scan 5)USG For Abscess Drainage

6. X rays findings in tubercular spondylitis Spread of infection is typically subligamentous(ALL) and anterior to vert body Ivory vertebra

7. Delineation and Localisation of Different types of abscess 1)Cervical 2)Thoracic 3)Lumbar

8. T1 COLLECTIONS SEEN IN B/L PSOAS, ANT,POST TO SPONDYLODISKITIS AT T11 TO L2,ERE SPIN,QUAD LUMBORUM S/O COLD ABSCESS T1 low signal in disc space (fluid) low signal in adjacent endplates (bone marrow edema)

9. T2W COLLECTIONS SEEN IN B/L PSOAS, ANT,POST TO SPONDYLODISKITIS AT T11 TO L2,ERE SPIN,QUAD LUMBORUM S/O COLD ABSCESS T2:  () high signal in disc space (fluid) high signal in adjacent endplates (bone marrow edema) loss of low signal cortex at endplates high signal in paravertebral soft tissues hyperintensity within the psoas muscle ( imaging psoas sign ): this finding is ~92% sensitive and ~92% specific for spondylodiskitis

10. T1C FATSAT COLLECTIONS SEEN IN B/L PSOAS, ANT,POST TO T11 TO L2,ERE SPIN,QUAD LUMBORUM WITH RING ENHANCEMENT S/O COLD ABSCESS T1 C+ ( Gd ) peripheral enhancement around fluid collection(s) enhancement of vertebral endplates enhancement of paravertebral soft tissues enhancement around low-density center indicates abscess formation

11. MRI CHARACTERISTICS IN TUBERCULAR SPONDYLITIS MRI is the imaging modality of choice due to its very high sensitivity and specificity. It is also useful in differentiating between pyogenic, tuberculous, and fungal infections, and a neoplastic process. Signal characteristics include: T1 low signal in disc space (fluid) low signal in adjacent endplates (bone marrow edema) T2:  (fat saturated or STIR especially useful) high signal in disc space (fluid) high signal in adjacent endplates (bone marrow edema) loss of low signal cortex at endplates high signal in paravertebral soft tissues hyperintensity within the psoas muscle ( imaging psoas sign ): this finding is ~92% sensitive and ~92% specific for spondylodiskitis T1 C+ ( Gd ) peripheral enhancement around fluid collection(s) enhancement of vertebral endplates enhancement of paravertebral soft tissues enhancement around low-density center indicates abscess formation (hard to distinguish inflammatory phlegmon from abscess without contrast) DWI hyperintense in the acute stage hypointense in the chronic stage The DWI sequence can help to distinguish between the acute(facilitated) and chronic stages(restricted) of the disease .

12. Based upon vertebral lesion location, mri distinguishes

13. Based upon lesion location they are classified as

14. DIFFERENTIAL DIAGNOSIS

15. Complication of spinal tb 1)Paraplegia (Potts Disease) 2)Cold Abscess 3)Spinal deformity 4)Sinus tracts 5)Secondary Infections

16. THANK YOU ALL KEEP SAFE IN CORONA PANDEMIC