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Discrimination of Tuberculous Spondylitis from Pyogenic Spondylitis on MRI

¹ Department of Diagnostic Radiology, Kangnam St. Mary's Hospital, The Catholic University of Korea, 505 Banpodong, Seocho-ku, Seoul 137-040, Korea.
² Department of Orthopedic Surgery, Kangnam St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
³ Department of Neurosurgery, Kangnam St. Mary's Hospital, The Catholic University of Korea. Seoul, Korea.

View larger version (136K): [in a new window]   Fig. 1A. —Typical tuberculous spondylitis in 53-year-old woman. Sagittal T1-weighted image (TR/TE, 547/12) shows heterogeneously hypointense signal (arrows) in T8–T9 vertebral bodies with epidural mass and subligamentous spread (arrowheads) from T7 to T10.

View larger version (121K): [in a new window]   Fig. 1B. —Typical tuberculous spondylitis in 53-year-old woman. T8 and T9 vertebral bodies are heterogeneously hyperintense (arrows) on sagittal turbo spin-echo T2-weighted image (3,000/112; echo-train length, 15).

View larger version (128K): [in a new window]   Fig. 1C. —Typical tuberculous spondylitis in 53-year-old woman. Sagittal fat-suppressed contrast-enhanced T1-weighted image (627/12) shows heterogeneous enhancement (arrows) of T8–T9 vertebral bodies. Intraosseous abscess (asterisk) is present.

View larger version (163K): [in a new window]   Fig. 1D. —Typical tuberculous spondylitis in 53-year-old woman. Axial fat-suppressed contrast-enhanced T1-weighted image (740/15) shows well-defined paraspinal abnormal enhancement (arrows) and thin and smooth rim enhancement of paraspinal abscess (asterisk). Prominent meningeal enhancement is present.

View larger version (126K): [in a new window]   Fig. 2A. —Typical pyogenic spondylitis in 53-year-old man. Sagittal T1-weighted image (TR/TE, 400/12) shows diffusely decreased signal intensity (arrows) in L4 through L5 vertebral bodies.

View larger version (118K): [in a new window]   Fig. 2B. —Typical pyogenic spondylitis in 53-year-old man. On sagittal turbo spin-echo T2-weighted image (3,200/99; echo-train length, 11) L4 and L5 vertebral bodies are isointense (arrows) to adjacent normal vertebrae.

View larger version (114K): [in a new window]   Fig. 2C. —Typical pyogenic spondylitis in 53-year-old man. Sagittal fat-suppressed contrast-enhanced T1-weighted image (400/12) shows diffuse heterogeneous enhancement (arrows) in the L4 and L5 vertebral bodies. Abscess (asterisk) is present in L4–5 disk space extending to L5 vertebral body.

View larger version (166K): [in a new window]   Fig. 2D. —Typical pyogenic spondylitis in 53-year-old man. Axial fat-suppressed contrast-enhanced T1-weighted image (800/15) shows thick and irregular rim enhancement of paraspinal abscess (asterisk). Ill-defined paraspinal abnormal enhancement (arrows) is present.

View larger version (101K): [in a new window]   Fig. 3A. —Pyogenic spondylitis in 66-year-old woman. Sagittal T1-weighted image (TR/TE, 400/11) shows hypointense signal (arrows) in L2–L3 vertebral bodies.

View larger version (113K): [in a new window]   Fig. 3B. —Pyogenic spondylitis in 66-year-old woman. On sagittal fast spin-echo T2-weighted image (3,000/112; echo-train length, 8) L2 and L3 vertebral bodies are isointense (arrows) to adjacent normal vertebrae with well-defined high signal (asterisk).

View larger version (121K): [in a new window]   Fig. 3C. —Pyogenic spondylitis in 66-year-old woman. Sagittal fat-suppressed contrast-enhanced T1-weighted image (600/11) shows heterogeneous enhancement (arrows) of L2 and L3 vertebral bodies with thin- and smooth-walled abscess (asterisk).

View larger version (137K): [in a new window]   Fig. 3D. —Pyogenic spondylitis in 66-year-old woman. Axial fat-suppressed contrast-enhanced T1-weighted image (550/14) shows relatively well-defined paraspinal abnormal enhancement (arrows).

View larger version (138K): [in a new window]   Fig. 4A. —Tuberculous spondylitis in 69-year-old woman. Sagittal T1-weighted image (TR/TE, 650/13) shows hypointense T12 vertebral body with compression. Adjacent hypointense paraspinal abnormal signal (black arrows) and epidural mass (white arrows) are present.

View larger version (145K): [in a new window]   Fig. 4B. —Tuberculous spondylitis in 69-year-old woman. T12 vertebral body is hypointense with internal high signal (arrows) on sagittal fast spin-echo T2-weighted image (2,500/118; echo-train length, 14).

View larger version (123K): [in a new window]   Fig. 4C. —Tuberculous spondylitis in 69-year-old woman. Sagittal fat-suppressed contrast-enhanced T1-weighted image (650/13) shows heterogeneous enhancement of T12 vertebral body with paraspinal abnormal enhancement (arrows) anteriorly. Epidural abscess (asterisk) is present.

View larger version (194K): [in a new window]   Fig. 4D. —Tuberculous spondylitis in 69-year-old woman. Axial fat-suppressed contrast-enhanced T1-weighted image (700/11) shows ill-defined paraspinal abnormal enhancement (arrows).

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