Analysis on 23 cases of spinal meningeal tuberculosis by magnetic resonance imaging

Abstract

To explore the imaging features of spinal cord and spinal meningeal tuberculosis by magnetic resonance (MR). We analyzed retrospectively the features of MRI in 23 patients with spinal cord and spinal meningeal tuberculosis compared to 25 patients with spinal cord meningeal metastatic carcinoma. All patients were admitted in our hospital from Jun. 2011 to Oct. 2014. There were 12 males and 11 females with a median age of 26 (range 16-50) years in the spinal cord meningeal tuberculosis group, and 18 males and 7 females with a median age 56 (range 44-78) years in the spinal cord meningeal metastatic carcinoma group. All patients underwent MR plain and contrast-enhanced scanning. The enumeration data were compared with the χ² test and the measurement data were compared with t test. The difference was considered statistically significant when the P value was <0.05. Of the 23 cases, 16 were spinal meningeal tuberculosis and 7 were spinal cord tuberculosis. The MR imaging features were as follows: (1) Spinal meningeal tuberculosis: Irregular and linear strip and hummocky thickening (thickness <5 mm) of the meninges (dura, arachnoid and pia mater), with the average length of involvement of 7 vertebral segments. Enhancement was present in all cases by contrast-enhanced scanning, including clustering or moniliform enhancement in 5 cases. Subarachnoid irregular stenosis was seen in all cases, partial occlusion in 5, abnormal heterogeneous signal in 20, rough cerebrospinal fluid (CSF)-spinal interface in 10, and formation of secondary arachnoid cyst in 15. (2) Spinal cord meningeal tuberculosis: of the 7 cases, 4 showed ring enhancement and 3 showed small plaque with heterogeneous enhancement. (3) There were 20 cases of meningeal metastatic carcinoma and 5 cases of meningeal metastatic carcinoma with spinal cord metastasis. Nodular thickening was present in 8 cases, plaque thickening in 10, and nodular and plaque thickening in 7. Continuous thickening involving 3 vertebral bodies was seen in 19 cases. Multiple localized thickening was present in 6 cases, with obvious enhancement in the meninges and heterogeneous enhancement in the spinal cord. The MR imaging features of spinal cord meningeal tuberculosis include continuous meningeal thickening, secondary arachnoid cyst, rough and moniliform CSF-spinal cord interface. Diagnosis and differential diagnosis can be made based on these features combined with clinical data and disease history.