<p>Differentiation of Intraspinal Tuberculosis and Metastatic Cancer Using Magnetic Resonance Imaging</p>

Abstract

This study aimed to explore the differences in the magnetic resonance imaging (MRI) findings between intraspinal tuberculosis and metastatic cancer, which may aid in making the correct diagnosis. Patients and Methods: The clinical features and MRI findings of 15 patients with intraspinal tuberculosis and 11 patients with intraspinal metastatic cancers were retrospectively analyzed. Results: The mean ages of the patients with intraspinal tuberculosis and metastatic cancer were 26.3 (15-42) and 52.1 (38-67) years, respectively. All intraspinal tuberculosis cases were secondary to primary extraspinal tuberculosis, including tuberculous meningitis (11/15), as well as pulmonary (9/15), vertebral (5/15), urinary tract (1/15), abdominal (1/15), cervical lymph node (1/15), and multisystem tuberculosis (9/15). The intraspinal metastases originated from the breast (5/11), lung (3/11), kidney (1/11), ovarian (1/11), and nasopharyngeal cancers (1/11). Both intraspinal tuberculosis and metastatic cancers presented with multiple intra-and extramedullary lesions throughout all regional segments of the spinal canal, accompanied by irregularly thickened meninges. Intraspinal tuberculous lesions had indistinct edges that integrated with each other, most of them exhibiting obvious enhancement on MRI. Conversely, intraspinal metastatic lesions were distinctly separated with clear edges and exhibited lesser enhanced MRI than intraspinal tuberculosis. Conclusion: A combined analysis of clinical features and MRI findings may be helpful in differentiating intraspinal tuberculosis from metastatic cancer.

Differentiation of Spinal Tuberculosis and Metastatic Spinal Tumor Using Mri Feature: A Systematic Review

“…Tuberculous leptomeningitis with intraspinal nodules was considered one of the most common features. In the study by Li et al (2020) T1-W1-weighted imaging showed thickened meninges. At the same time, Saxena et al (2021) found no enhancement of leptomeningitis in a few patients.…”

“…Involvement of vertebral body, lamina, pedicles, and spinous was seen more in the metastatic spine (75% of metastasis and 70% of Pott's spine cases) (Garg & Somvanshi, 2011). Whereas in the study by Li, et al (2020), it was found that in 5 of 15 spinal tuberculosis patients, the affected side was the thoracic region, in five patients the lumbar and sacral regions, and in five other patients more than two spinal cord regions were involved. Metastasis with each thoracic and lumbar lesion was seen in one of eleven patients, with one instance impacting the whole spinal cord and the other nine affecting more than two locations (Mertaniasih, et al, 2019).…”

“…The nodular lesions' edges are a key factor in seeing the difference. Metastases have well-separated lesion margins and show lower MRI-enhanced (Li et al, 2020) Sixty-five percent of patients with metastases and twenty percent of individuals with tuberculous spondylitis have skip lesions. The thoracic spine was the most prevalent location for skip lesions, followed by the thoracolumbar and cervical-thoracic regions.…”

“…Contrast-enhanced MRI imaging may not help differentiate tuberculous leptomeningitis from metastatic lesions. It may be due to different scanning protocols, contrast agents, and inclusion criteria for the included patients (Li, et al, 2020).…”

Diagnosis and management of intraspinal tuberculoma with osseous involvement: a case report

“…The lesion of intraspinal tuberculoma can exist in epidural, intradural, and intramedullary space, causing spinal cord compression. Due to the distribution of blood supply to spinal cord, thoracic segment receives nearly 45% of spinal cord blood supply resulted in intraspinal tuberculoma was most commonly found in the thoracic segments 11 . Our patient is a 31-year-old male with a history of tuberculosis of pulmonary and intestinal, MRI and CT images of the spine demonstrated a contrast-enhancing extradural lesion with vertebral body destruction at T2–T4 causing significant spinal cord compression.…”