Tuberculosis (TB) is no longer a disease limited to developing nations and is still a major cause of significant morbidity and mortality worldwide. The indolent clinical presentation, emergence of multidrug-resistant mycobacteria, and association with human immunodeficiency virus infection poses obstacles for early diagnosis and management. Compared with the other forms of TB, musculoskeletal involvement is relatively rare. Tuberculous spondylitis is the most common form of musculoskeletal TB and accounts for ~50% of cases. Extraspinal musculoskeletal TB shows a predilection for large weightbearing joints, long bones, and the skull. This article reviews the radiologic features of diverse forms of osseous TB and the diagnostic value of the different imaging techniques. It also reviews the imaging differential diagnoses, including other infections and malignancies/metastases. Conventional radiography is of key value in the diagnosis of musculoskeletal TB. Computed tomography, magnetic resonance imaging, and bone scintigraphy also play key roles in the early detection of disease and in demonstrating the extent of disease process and soft tissue involvement. Because delay in treatment significantly reduces the cure rate and increases the rate of complications and morbidity, early radiological diagnosis of TB is of paramount importance for appropriate management.
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