Demonstration of intramedullary tuberculomas by magnetic resonance imaging: a report of two cases

Abstract

Intramedullary tuberculomas are rare (Arseni & Samitca, 1960; Dastur, 1972; Compton & Dorsch, 1984) but have been demonstrated either at surgery or at autopsy. The appearance of tuberculomas in the brain on magnetic resonance imaging (MRI) has been reported (Gupta et al, 1988). However, the image morphology of intrinsic cord tuberculomas has not been described. We present the MR findings in two patients with tuberculomas of the cervical cord diagnosed on the basis of positive therapeutic response to antituberculous therapy (ATT). Two young patients with clinical and radiological evidence of intramedullary pathology, who were referred for MRI study with possibility of tuberculous myelitis, are described. Magnetic resonance imaging of the cervicodorsal spine was performed with a 1.5 T (MAGNETOM, Siemens) system using spin echo sequences (repetition time (TR), 2000 ms and echo time (TE), 69–90 ms for T₂ images; TR, 700–800 ms and TE, 17–22 ms for T₁ images) in axial and sagittal planes. Images were acquired on 256 × 256 matrix and 1.2 gradient zooming with 5 mm contiguous slices. Follow-up studies in both cases were taken after 4 months and after 1 year in Case 2. from C2 to C5/C6 (Figs la & b). The extradural space and vertebral bodies were found to be normal. The lesion appeared to be hypointense in its periphery with central hyperintensity on T₂-weighted images and low to isointense on T₁ images. The patient showed remarkable relief of her symptoms over a period of 4 months with ATT.