AJR:168, March 1997 807 MR Imaging of Tubercular Spinal Arachnoiditis Aseem Sharma1 Mayank Goyal Nalin K. Mishra Vivek Gupta Shailesh B. Gaikwad OBJECTIVE. The purpose of our study was to examine the spectrum of abnormalities seen on MR imaging in patients with tubercular spinal arachnoiditis. MATERIALS AND METHODS. A retrospective analysis of MR findings in 22 cases of tubercular spinal arachnoiditis was carried out. The diagnosis had been established on the basis of clinical features, evidence of associated tubercular meningitis or of tubercu- lar spondylitis. and CSF analysis. RESULTS. Nineteen (86%) patients had involvement of more than one spinal region, with the dorsal regiomi being most commonly involved. CSF showed increased signal inten- sity on TI-weighted images in 17 (77%) patients. leading to complete loss of cord-CSF interface in seven patients and shaggy cord outline in 10 patients. As suggested by increased signal intensity on T2-weighted images. we saw cord involvement in 18 (82%) patients. Three of these patients had evidence of cord cavitation. Other findings seen on unenhanced images were CSF loculations in five patients. nodules in subarachnoid space in six patients. and clumping of cauda equina nerve roots in six patients. Contrast-enhanced studies were available in 20 patients. Meningeal enhancement was seen in 16 (80%) of 20 patients, and nerve root enhancement was seen in six (30%) patients. Cord enhancement was seen in four (20% ) of 20 patients. Enhancement was observed along the surface of the cord in two of these patients. whereas the other two patients showed central enhancement. Associated findings were tubercular spondylitis in two patients. basal exudate in eight patients. and intracranial granulomas in five patients. CONCLUSION. MR imaging revealed several pathologic changes that occur in patients with tubercular spimial arachnoiditis and, hence. niay play an important role in the diagnosis of this emitity. Received July 8, i996; accepted after revision September 5, 1996. 1Jl authors: DepartmentofNeuroradiology, Neurosciences Centre,All India lnstituteofMedicalSciences,Ansan Nagar, New Delhi-i10029, India. Address correspondence to M. Goyal. AJR1997;i68:807-812 O36i-8O3XJ97/i683-8O7 © American Roentgen Ray Society T uberculosis is an inip()rtamit. potentially treatable cause of spi- nal arachnoiditis. Tubercular infection is common in third-world countries and is showing arm increasing trend in the West because ofthe high prevalence of AIDS [1. 21. Frequently associated radiculomyelitis makes tubercular arachnoiditis distinct from other causes. which include surgery. sub- arachnoid bleeding. and intrathecal adminis- tration of anesthetic agents or myelographic contrast mnedia. The diagnosis of tubercular spinal arachnoiditis is usually based on clini- cal features. CSF analysis. evidence of tuber- culosis elsewhere in the body (especially meningitis). and characteristic myelographic findings. Myelography has played an impor- tant role in the diagnosis of spinal arachnoidi- tis. However. recent literature has shown MR imaging to be useful in diagnosing spinal arachnoiditis 13-51. Most of these studies have been carried out in patients with spinal ar’achnoiditis of mioninfectious causes. The lit- erature on MR iniaging findings of tubercular spinal arachnoiditis is scant II . 6-8]. To our knowledge. the only study dealing with a size- able number of patients 171 includes patients with all forms of intraspinal tuberculosis. includ- ing arachnoiditis. intraniedullary tuberculonias, and epidural abscess. The aim of the present study was to highlight the spectrum of MR imaging findings seen in patients with a specific fonn of intra.spinal tuberculosis. tubercular spi- nal arachnoiditis. Materials and Methods MR imaging examinations were pertuirmed in 22 patietits with spinal arachnoiditis of tubercular origin during the last 3 years at our institution. A retrospec- tive review t)f MR iniaging studies of these patients was carried out. Patients included IS niales and sevemi females, who were 7-70 years old (mean ± SD. 32.7 ± I 7.0 years tild). None of the patients was ininiunocompromnised. The diagmiosis of tubercular spinal arachnoiditis was based on clinical features (onset of niyelopathy in a known case of tubercular menimigitis). CSF analysis. evidence of tuberculosis elsewhere in the body. and iniaging findings. All MR mmages were obtaimied on a system equipped with a I .5-T supercomiducting magnet ( Magnetomii: Siernemis. Erlamigen. Germany ). All studmes mmicluded ‘otgtttal T I -weighted (TR rangelFE Downloaded from www.ajronline.org by 171.243.65.178 on 05/21/23 from IP address 171.243.65.178. Copyright ARRS. For personal use only; all rights reserved
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