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Year :2016
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Month :
July-August
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Volume :
5
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Issue :
3
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Page :
-
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Tubercular Spondylitis: Prospective
Comparative Imaging Analysis on
Conventional Radiograph and MRI
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Correspondence Address :
Gaurav Sharma, Rita Ghode,
Dr. Gaurav Sharma,
Flat No. 101, Gajanan Shivani Apartment, Tiwari Layout,
Sawangi Bypass, Sawangi, Wardha 442001. Maharashtra,
India.
E-mail: drgsharma78@gmail.com
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Introduction: Introduction: Tuberculosis remains a major health hazard with a rebound insurgency with increasing incidence of HIV. Skeletal involvement occurs in 1-3% of patients with tuberculosis and spine accounts for almost 50% cases of skeletal tuberculosis. Imaging plays an important role in managing spinal tuberculosis by making a prompt diagnosis so as to prevent irreversible neurological deficit and spinal deformity. During this era of cross sectional imaging, plain radiography can still provides important information necessary for diagnosis, however disease may not be apparent for upto 8 weeks and or involvement of 30-50% of the vertebra. MRI remains the standard imaging modality with its high contrast resolution, multiplanar capacity and ease of assessment of spinal cord and neural element.
Aim: To compare and correlate the imaging findings of tubercular spondylitis on plain radiograph and MRI.
Materials and Methods: This was prospective diagnostic study carried out over 1 year of period in the department of radio diagnosis, JR Tantia Charitable Trust and Rural Hospital, comprising a sample size of 32 patients. The various spinal imaging findings were prospectively evaluated and compared on plain radiograph and MRI.
Results: A definite level of lesion could be localised in 27(84.3%) on radiograph while MRI could localized the disease in all 32(100%) patients. Thoracic spine was the most common site on both plain radiograph and MRI. Paradiskal with posterior location 15(46.8%) was commonest pattern of vertebral involvement on MRI while plain radiograph could localized mostly paradiskal lesion 24(88.8%). Both modalities could detect vertebral body destruction, reduced disc height in equal number of patients (19). Skip lesion was seen in 4(12.5%) cases on MRI and in 2 (7.4%) on plain radiograph. Paravertebral soft tissue mass was evident in 26(81.2%) patients on MRI and in 15(55.5%) on plain radiograph. The two modalities showed a moderate agreement (k value: 0.685) amongst them for detection of skip lesion while they showed poor agreement (k value: 0.09) for detection of paravertebral soft tissue mass. The two modalities showed a perfect agreement (k value:1) for evaluation of reduced disc height.
Conclusion: Plain radiograph does reveal the important diagnostic imaging findings and serves as the initial first line imaging modality due to its cost effectiveness and availability. However, MRI is more sensitive, specific and accurate than plain radiography in the diagnosis of spinal tuberculosis.
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