NEURORADIOLOGY

Case 6 : (MRI)

A 50-year-old female presented with history of sciatica-like pain and low-grade fever. Clinical examination revealed tenderness at L3-L4 level. ESR was 32. Rest of the lab parameters were normal. Radiographs of lumbar spine revealed a minimal reduction in L3-L4 disc space. MRI spine was performed.

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Imaging Findings

Mid-sagittal T1/T2 WI revealed altered signal intensity changes involving L3 and L4 vertebral bodies. Although the L3-L4 disc showed reduction in height, margins were well maintained. Minimal anterior epidural granulation tissue/ abscess was seen at L3-L4 level. There was no prevertebral or para spinal extension. Coronal fast scan T2WI showed vertebral signal intensity changes.

Diagnosis

This is a typical case of early tuberculous spondylitis, with involvement of adjacent vertebral bodies and epidural extension of the granulation tissue. X-rays were normal as there was no destruction of the vertebral bodies or intervertebral discs or para-spinal extension of the granulation tissue.

MRI detects these cases earlier as it is sensitive to bone marrow changes that occur earlier than bone or disc destruction.

This case is a classical example of this situation.

Contribution

Dr. Deepak Patkar, MRI Nanavati, Mumbai.