Clinical and radiological characteristics of parenchymal and meningeal spinal tuberculosis

Abstract

Background: Spinal tuberculosis is a rare condition that can result in significant neurological impairments. It is typically classified into two main types based on the anatomical involvement: parenchymal and meningeal. However, existing studies have not provided systematic reports that clarify the differences in aetiology, pathophysiological mechanisms, and clinical presentations between these two types.

Methods: This retrospective study includes 107 patients diagnosed with intracranial tuberculosis accompanied by spinal tuberculosis via magnetic resonance imaging (MRI) between May 2019 and May 2024 at our hospital. Patients are categorised into parenchymal and meningeal types based on radiological manifestations. Clinical symptoms, comorbidities, peripheral blood and cerebrospinal fluid laboratory indices, and MRI data are collected for both groups. Statistical analyses are performed using Chi-square tests, independent sample t-tests and non-parametric tests.

Results: Parenchymal spinal tuberculosis is more frequently associated with haematogenous pulmonary dissemination, exhibits a stronger inflammatory response and is linked to poorer nutritional status. Meningeal spinal tuberculosis often co-occurs with tuberculous meningitis, with common symptoms including sensory and motor deficits and lumbar back pain. Further, MRI findings indicate that parenchymal tuberculosis predominantly features nodular lesions, whereas meningeal tuberculosis is characterised by dural linear or leptomeningeal enhancement.

Conclusion: Significant differences exist in the clinical and radiological manifestations of parenchymal and meningeal spinal tuberculosis, and MRI enhancement scans play a crucial role in diagnosis, aiding in the optimisation of diagnostic and treatment strategies.

Keywords: Magnetic resonance imaging; Meningeal type; Parenchymal type; Spinal tuberculosis.

Fig. 1

The representative MRI imaging of parenchymal spinal tuberculosis. A-C: A 44-year-old female case with parenchymal spinal tuberculosis at the level of the 12th thoracic vertebra. (A): The image displays a lumbar spine T₂WI sagittal sagittal view showing a round high-signal nodule at the T12 level of the thoracic spinal cord (white arrow); (B): The image shows a lumbar spine fat-suppressed T₂WI view with the lesion appearing hyperintense at the T12 level of the thoracic spinal cord; (C): The image presents a lumbar spine T₁WI post-contrast sagittal view depicting nodular enhancement of the lesion. D-F: A 33-year-old man case with parenchymal spinal tuberculosis at cervical segment. (D): The image illustrates a cervical spine T₂WI sagittal view showing extensive edema of the cervical spinal cord with a mixed-signal nodule at the C5 level, central high-signal and peripheral slightly low-signal (white arrow); (E): The image depicts a cervical spine T₁WI sagittal view with the lesion’s periphery appearing slightly hyperintense and the center hypointense (white arrow); (F): The image exhibits partial lesions with ring enhancement (white arrow) and others with nodular enhancement (hollow white arrow) on a cervical spine T₁WI post-contrast sagittal view

Fig. 2

The representative MRI imaging of meningeal spinal tuberculosis. A-D: A 20-year-old man case with meningeal spinal tuberculosis at cervical segment. (A): The image presents a cervical spine T₂WI sagittal view with no abnormalities in the cervical spinal cord; (B): The image shows a cervical spine T₁WI sagittal view also with no abnormalities; (C): The STIR image appears normal; (D): The image depicts a cervical spine T1WI post-contrast sagittal view demonstrating leptomeningeal enhancement of the ventral and dorsal surfaces of the cervical spinal cord (white arrow). E-I: A 10-year-old man case with meningeal spinal tuberculosis at thoracic segment. (E): The image illustrates a thoracic spine T₂WI sagittal view showing extensive edema of the thoracic spinal cord (white arrow), high signal shadow at vertebral body of 7th thoracic vertebra (white hollow arrow); (F): The image depicts a thoracic spine T₁WI sagittal view at the T6-T7 level showing a slightly hyperintense dural nodular lesion posterior to the thoracic spinal cord (white arrow), low signal shadow at 7th thoracic vertebra (white hollow arrow); (G): STIR image shows the thoracic spinal cord edema induced by the compression of intraspinal meningeal tuberculoma (white arrow), pachymeningeal nodules with mixed signals in chest 6–7 spinal cord (black arrow), high signal shadow at 7th thoracic vertebra (white hollow arrow). (H): The image presents a thoracic spine T₁WI post-contrast sagittal view at the T6-T7 level with significant enhancement of the nodular signal posterior to the thoracic spinal cord (white arrow), and additional linear enhancement of the ventral and dorsal soft meninges of the thoracic spinal cord (hollow white arrow); (I): The image presents a thoracic spine T₂WI axial view with central canal dilation of the thoracic spinal cord (white arrow) and adhesions in the subarachnoid space with cerebrospinal fluid accumulation causing compression and leftward

Fig. 3

The representative MRI imaging of mixed spinal tuberculosis. A-D: A 19-year-old female case with mixed spinal tuberculosis at cervical and upper thoracic segments. (A-B): Sagittal T2WI shows a patchy high signal (white arrow, A) and T1WI shows a patchy slightly low signal (white arrow, B) within the spinal cord at the C7-T1 level. (C): STIR image demonstrates a patchy high signal within the spinal cord at the C7-T1 level (white arrow). (D): T1WI post-contrast scan shows homogeneous enhancement of the intramedullary lesion (white arrow) and leptomeningeal enhancement along the cervical and upper thoracic spinal cord (hollow white arrow)