Demonstration of intramedullary tuberculomas by magnetic resonance imaging: a report of two cases

Abstract

Intramedullary tuberculomas are rare (Arseni & Samitca, 1960; Dastur, 1972; Compton & Dorsch, 1984) but have been demonstrated either at surgery or at autopsy. The appearance of tuberculomas in the brain on magnetic resonance imaging (MRI) has been reported (Gupta et al, 1988). However, the image morphology of intrinsic cord tuberculomas has not been described. We present the MR findings in two patients with tuberculomas of the cervical cord diagnosed on the basis of positive therapeutic response to antituberculous therapy (ATT). Two young patients with clinical and radiological evidence of intramedullary pathology, who were referred for MRI study with possibility of tuberculous myelitis, are described. Magnetic resonance imaging of the cervicodorsal spine was performed with a 1.5 T (MAGNETOM, Siemens) system using spin echo sequences (repetition time (TR), 2000 ms and echo time (TE), 69–90 ms for T2 images; TR, 700–800 ms and TE, 17–22 ms for T1 images) in axial and sagittal planes. Images were acquired on 256 × 256 matrix and 1.2 gradient zooming with 5 mm contiguous slices. Follow-up studies in both cases were taken after 4 months and after 1 year in Case 2. from C2 to C5/C6 (Figs la & b). The extradural space and vertebral bodies were found to be normal. The lesion appeared to be hypointense in its periphery with central hyperintensity on T2-weighted images and low to isointense on T1 images. The patient showed remarkable relief of her symptoms over a period of 4 months with ATT.

Magnetic Resonance evaluation of tubercular lesion in spine

“…Desai [1] had reported an extradural granuloma in 6/24 (25%) cases. Dhammi et al [31] and Jena et al [32] reported intramedullary granuloma in tubercular spine which resolved on ATT.…”

“…Other series have also reported almost 100% incidence of marrow oedema in cases of TB spine [1][2][3][4][5][6][7][8][9][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. The caseous exudative type was more common (48/49 cases, 158/161 VB) while 3/161 (1.86%) VB had the granular type (Table 2).…”

Spinal tuberculomas mimicking spinal dural arteriovenous fistula: A case report

“…Commonly the intramedullary tuberculomas have specific MR features and can be diagnosed on imaging. It has a typical "target sign" on T2weighted imaging, demonstrating low signal center (caseous material) surrounded by high signal rim (peripheral infective granulation tissue), which helps to differentiate tuberculoma from other intramedullary lesions [10,11]. On intravenous contrast study, these lesions show rounded nodular and ring like peripheral enhancement with nonenhancing center of the lesion.…”

“…On intravenous contrast study, these lesions show rounded nodular and ring like peripheral enhancement with nonenhancing center of the lesion. If the lesion has a typical appearance on MRI, and if the patient has systemic tuberculosis, diagnosis of tuberculoma can be made easily [9][10][11]. If the patient does not have systemic tuberculosis and has immunocompromised status, MRI features can be atypical as seen in our case and diagnosis can be difficult.…”

Intramedullary spinal tuberculoma presenting as a conus tumor: a case report and review of the literature

“…MRI is the best diagnostic tool to show the location, size and number of the lesions [9,10,12,19]. Jena et al [11], in 1991, demonstrated the MRI characteristics of intramedullary tuberculomas as low intensity rings with or without central hyperintensity (because of the varying amount of caseous necrosis) on T2-weighted images and low to isointense rings on T1-weighted images. Rhoton et al [19], in 1988, presented the first known description of MRI of intramedullary spinal cord tuberculomas.…”