Diagnostic accuracy of whole spine magnetic resonance imaging in spinal tuberculosis validated through tissue studies

  • Rishi M. KannaEmail author
  • Naveen Babu
  • Muhil Kannan
  • Ajoy P. Shetty
  • S. Rajasekaran
Original Article



Conventional diagnosis of spinal tuberculosis (TB) is based on a combination of clinical features, laboratory tests and imaging studies, since none of these individual diagnostic features are confirmatory. Despite the high sensitivity of MRI findings in evaluating spinal infections, its efficacy in diagnosing spinal TB is less emphasized and remains unvalidated through tissue studies.


We reviewed consecutive patients evaluated for spondylodiscitis with documented clinical findings, MRI spine, and tissue analysis for histopathology, TB culture and genetic TB PCR. MRI features documented include location, contiguous/non-contiguous skip lesions, para/intraosseous abscess, subligamentous spread, vertebral collapse, abscess size/wall, disc involvement, end plate erosion and epidural abscess. Based on the results, patients were divided into two groups—CONFIRMED TB with positive culture/histopathology and NON-TB. The efficacy of MRI findings in accurately diagnosing spinal TB was compared between the two groups.


Among 150 patients, 79 patients were TB positive, and 71 were TB negative. Three MRI parameters showed significant differences (p < 0.001), namely subligamentous spread (67/79, 84.8%), vertebral collapse > 50% (55/79, 69.6%) and large abscess collection with thin abscess wall (72/79, 91.1%) being strongly predictive of TB. Combination of MRI findings had a higher predictive value. 97.5% of TB positive patients had at least one of these three MRI features, 89.8% patients had any two and 58.2% had all three.


Our study validated different MRI findings with tissue studies and showed spinal infections with large abscess with thin wall, subligamentous spread of abscess and vertebral collapse were highly suggestive of spinal tuberculosis.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Spinal tuberculosis Magnetic resonance imaging Abscess Sensitivity Predictive value 



The study was funded by the Ganga Orthopaedic Research and Education Foundation (GOREF).

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest.

Supplementary material

586_2019_6031_MOESM1_ESM.pptx (2.3 mb)
Supplementary material 1 (PPTX 2355 kb)


  1. 1.
    Pertuiset E, Beaudreuil J, Lioté F, Horusitzky A, Kemiche F, Richette P et al (1999) Spinal tuberculosis in adults. A study of 103 cases in a developed country, 1980–1994. Medicine (Baltimore) 78(5):309–320CrossRefGoogle Scholar
  2. 2.
    Kotil K, Alan MS, Bilge T (2007) Medical management of Pott disease in the thoracic and lumbar spine: a prospective clinical study. J Neurosurg Spine 6(3):222–228CrossRefGoogle Scholar
  3. 3.
    Desai SS (1994) Early diagnosis of spinal tuberculosis by MRI. J Bone Joint Surg Br 76(6):863–869CrossRefGoogle Scholar
  4. 4.
    Watts HG, Lifeso RM (1996) Tuberculosis of bones and joints. J Bone Joint Surg Am 78(2):288–298CrossRefGoogle Scholar
  5. 5.
    Lakhanpal VP, Tuli SM, Hardas Singh, Sen PC (1974) The value of histology, culture and guinea pig inoculation examination in osteoarticular tuberculosis. Acta Orthop Scand 45:36–42CrossRefGoogle Scholar
  6. 6.
    Jain AK, Sreenivasan R, Saini NS, Kumar S, Jain S, Dhammi IK (2012) Magnetic resonance evaluation of tubercular lesion in spine. Int Orthop 36(2):261–269CrossRefGoogle Scholar
  7. 7.
    Jain AK, Jena A, Dhammi IK (2000) Correlation of clinical course with magnetic resonance imaging in tuberculous myelopathy. Neurol India 48:132–139Google Scholar
  8. 8.
    Yao DC, Sartoris DJ (1995) Musculoskeletal tuberculosis. Radiol Clin N Am 33:679–689Google Scholar
  9. 9.
    Engin G, Acunas B, Acunas G, Tunaci M (2000) Imaging of extrapulmonary tuberculosis. RadioGraphics 20:471–488CrossRefGoogle Scholar
  10. 10.
    Jung NY, Jee WH, Ha KY, Park CK, Byun JY (2004) Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. Am J Roentgenol 182(6):1405–1410CrossRefGoogle Scholar
  11. 11.
    Shanley DJ (1995) Tuberculosis of the spine: imaging features. Am J Roentgenol 164(3):659–664CrossRefGoogle Scholar
  12. 12.
    Moorthy S, Prabhu NK (2002) Spectrum of MR imaging findings in spinal tuberculosis. Am J Roentgenol 179(4):979–983CrossRefGoogle Scholar
  13. 13.
    Chang MC, Wu HT, Lee CH, Liu CL, Chen TH (2006) Tuberculous spondylitis and pyogenic spondylitis: comparative magnetic resonance imaging features. Spine (Phila Pa 1976) 31(7):782–788CrossRefGoogle Scholar
  14. 14.
    Mahboubi S, Morris MC (2001) Imaging of spinal infections in children. Radiol Clin N Am 39(2):215–222CrossRefGoogle Scholar
  15. 15.
    Joseffer SS, Cooper PR (2005) Modern imaging of spinal tuberculosis. J Neurosurg Spine 2(2):145–150CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Rishi M. Kanna
    • 1
    Email author
  • Naveen Babu
    • 1
  • Muhil Kannan
    • 2
  • Ajoy P. Shetty
    • 1
  • S. Rajasekaran
    • 1
  1. 1.Department of Orthopaedics and Spine SurgeryGanga HospitalCoimbatoreIndia
  2. 2.Department of RadiologyGanga HospitalCoimbatoreIndia

Personalised recommendations