Role of T1 Ratio of Marrow, Diffusion-Weighted Imaging, and Chemical Shift Imaging in Multiparametric MRI of the Spine in Spinal Tuberculosis.

Objective This study aimed to evaluate the role of multi-parametric magnetic resonance imaging (MRI) modalities in enhancing the diagnostic accuracy of spinal tuberculosis and improving the overall clinical approach to this complex condition. Methodology A total of 50 patients diagnosed with spinal tuberculosis were enrolled in the study. Multi-parametric MRI sequences, including T1-weighted imaging, diffusion-weighted imaging (DWI), and chemical shift imaging (CSI), were performed to assess marrow involvement, diffusion restriction, and fat content within the lesions. Clinical staging of spinal tuberculosis was conducted based on conventional imaging and clinical parameters. Correlations between MRI findings and disease stage were subsequently analyzed. Results The study found that significant alterations in the T1 marrow ratio and low apparent diffusion coefficient (ADC) values on DWI were associated with advanced stages of spinal tuberculosis. CSI revealed the presence of fat within granulomatous lesions more frequently in later stages. Among all modalities, DWI demonstrated the highest diagnostic sensitivity and specificity (90% and 85%, respectively), followed by the T1 marrow ratio and CSI. A statistically significant correlation was observed between MRI parameters and clinical staging, highlighting the value of multi-parametric MRI in disease staging. Conclusion Multi-parametric MRI - integrating the T1 marrow ratio, DWI, and CSI - proves to be a valuable, noninvasive tool for the early detection, staging, and monitoring of spinal tuberculosis. The findings indicate that DWI offers the highest diagnostic accuracy, underscoring its importance in evaluating spinal tuberculosis. The study supports the integration of advanced MRI techniques into routine clinical practice for more accurate diagnosis and treatment planning.