Role of magnetic resonance diffusion imaging and apparent diffusion coefficient values in the evaluation of spinal tuberculosis in Indian patients

Aim: To define a range of apparent diffusion coefficient values in spinal tuberculosis and to evaluate the sensitivity of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient values in patients of spinal tuberculosis. Materials and Methods: This study was conducted over a period of 20 months and included 110 patients with a total of 230 vertebral bodies. The study was performed in two parts. The first part included all patients of known tuberculosis and patients with classical features of tuberculosis. The second part included patients with spinal pathology of indeterminate etiology. All the patients underwent a routine MRI examination along with diffusion sequences. The apparent diffusion coefficient (ADC) values were calculated from all the involved vertebral bodies. Results: The mean ADC value of affected vertebrae in first part of the study was found to be 1.4 ± 0.20 ×10 -3 mm 2 /s. This ADC value was then applied to patients in the second part of study in order to determine its ability in predicting tuberculosis. This range of ADC values was significantly different from the mean ADC values of normal vertebrae and those with metastatic involvement. However, there was an overlap of ADC values in a few tuberculous vertebrae with the ADC values in metastatic vertebrae. Conclusion: We found that DW-MRI and ADC values may help in the differentiation of spinal tuberculosis from other lesions of similar appearance. However, an overlap of ADC values was noted with those of metastatic vertebrae. Therefore diffusion imaging and ADC values must always be interpreted in association with clinical history and routine MRI findings and not in isolation.