Magnetic Resonance Imaging Features In Patients With Spinal Tuberculosis At Muhimbili Orthopedic Institute And Muhimbili National Hospital

Abstract

Magnetic Resonance Imaging has become the best imaging modality to evaluate patients with spinal tuberculosis, which is an indolent disease, leads to neurological disability, following delay in diagnosis and treatment. It is known to be sensitive and specific, thus avoiding the other invasive diagnostic investigations. It has improved contrast resolution for bone and soft tissue along with versatility of direct imaging in multiple planes, aiding in the diagnosis and management of the patients. Broad objective: This study aimed to determine the Magnetic Resonance Imaging (MRI) features in patients with spinal tuberculosis attending MOI/MNH from January 2020 to January 2021 Methodology: This was a hospital-based descriptive retrospective cross-sectional study, where medical records and spine Magnetic Resonance images of patients who underwent spine MRI at Muhimbili Orthopedic institute and Muhimbili National Hospital were reviewed. The diagnosis of spinal tuberculosis was reached by clinical features and the MRI spinal TB criteria which are a well-defined Para spinal abnormal signal, thin and smooth abscess wall, sub ligamentous spread and multiple or entire body involvement. Structured questionnaire formulated by the Prinicipal Investigator was used for recording patient’s demographics, clinical features and MR imaging features. The images were interpreted by the Principal Investigator and a Radiologist. Data analysis was done using SPSS. Results were summarized using tables. P value ≤ 0.05 was considered to be statistically significant. Results: During this study period spine MRI images and medical records of 58 patients were retrospectively reviewed. A total of 49 patients were diagnosed to have spinal TB, using the spinal TB MRI criteria. The disease was most commonly seen in young adults with male predominance, 27 patients (55.1%). Elevated ESR level was the most common clinical feature in 87.9%, P value =0.036, followed by back pain in 79.3% and Para paresis in 31%. The dorsal spine was the most common affected, 32 patients (55.2%). The spine MRI features included multiple vertebral body involvement in 48 patients (82.6%), kyphotic vertebral alignment in vi 26 patients, (44.8%), vertebral height reduction in 84.4%, intervertebral disc involvement in 23 patients, (44.8%) and vertebral body edema in 54 patients, (93.1%). This study found association between T1WI hypo intense signal, STIR hyper intense signal with spinal TB, P value =0.022. Also this study found association between contrast enhancement and spinal TB P value=0.006. Conclusion: In patients suspected of spinal TB, Spine MRI including T1WI, STIR sequences and T1WI with contrast medium should be warranted. Recommendation: This research opens the door for research with large sample size and longer time, which needs to be done on this topic to define more accurately the spinal TB MRI features and true burden of Spinal tuberculosis in our setting. Role of MRI were ever available should be encouraged for diagnosis and follow-up of the patients