Intramedullary tuberculomas. MR findings in seven patients

Purpose: To describe the MR findings in intramedullary tuberculomas and to discuss the usefulness of MR in the management of this pathology.Material and Methods: A retrospective study of 7 patients from 21 to 60 years of age with clinical and radiological evidence of intramedullary tuberculomas was undertaken. Both T1- and T2-weighted images (WI) were obtained along with postcontrast T1WI. Signal intensities (SIs) of the granulomas were compared with SIs of the normal spinal cord.Results: Six patients showed focus of tuberculosis elsewhere in the body. Six out of 7 showed fusiform swelling of the cord. Ill-defined iso-intensity (in 4 patients) to hyperintensity (in 3 patients) was seen at the site of granuloma on T1WI. On T2WI, 2 patients revealed a hypointense area (with disc enhancement). An iso-hypointense rim was seen surrounding a hyperintense centre in 5 patients (with rim enhancement). Adjacent oedema was seen in all patients. In 2 patients meningeal enhancement was also seen. In 2 patients the histopathology following surgical biopsy confirmed the diagnosis. In the remaining 5 patients, another known focus of tuberculosis elsewhere in the body and a marked response to antitubercular treatment was considered confirmatory for tuberculomas.Conclusion: Hypo- or iso-intensity on T2WI within the spinal cord with surrounding hyperintense oedema is suggestive of intramedullary tuberculomas. Central hyperintensities are also detected at times due to a variable amount of caseous necrosis with liquefaction. On T1WI, fusiform swelling of the cord is seen along with iso- to hyperintense foci, surrounded by hypointense oedema of the cord. Such findings should prompt a contrast-enhanced study, which may show single or conglomerate disc- or ring-enhancing lesions. MR thus plays an important role not only in detection and diagnosis, but also in deciding the treatment options and in the follow-up of those patients.