MRI in intracranial tuberculosis: Have we seen it all?

Baloji, Abhiman; Ghasi, Rohini Gupta

doi:10.1016/j.clinimag.2020.08.028

Cited by 12 publications

(21 citation statements)

References 52 publications

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“…Most patients with intracranial TB die within the first six months, especially those with miliary TB. Early diagnosis and treatment is an important factor in improving the prognosis of patients with intracranial TB (9)(10)(11). The gold standard for the diagnosis of intracranial TB is positive CSF smear or culture (9).…”

Section: Discussionmentioning

confidence: 99%

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Relationship between magnetic resonance imaging findings and prognosis of intracranial tuberculosis

Yang

Wang

et al. 2021

Acta Radiol

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Background Intracranial tuberculosis (TB) is an intracranial infection caused by Mycobacterium tuberculosis. Magnetic resonance imaging (MRI), in particular enhanced MRI scan, has the ability to detect characteristic lesions of tuberculous meningitis or cerebral parenchymal TB. Purpose To analyze the relationship between MRI findings and prognosis of patients with intracranial TB. Material and Methods In this retrospective study, a total of 60 patients were confirmed with intracranial TB in the hospital from May 2019 to December 2020. All enrolled patients underwent TB-related laboratory examinations, cranial MRI, and contrast-enhanced MRI. Laboratory tests were analyzed and the relationship between clinical prognosis and cranial MRI features was evaluated. Results Of the 60 patients, 28 (46.67%) had disseminated TB complications, 20 (36.67%) had secondary TB complications, and the remaining 10 (16.66%) had lymphatic TB or spinal TB complications. Of the patients, 25 had good short-term prognosis and 35 had poor short-term prognosis; 44 patients had good long-term prognosis and 16 had poor long-term prognosis. The incidence of cerebral parenchymal tuberculomas on enhanced MRI was significantly higher in the group with good prognosis compared to that in the group with poor prognosis ( P < 0.05). Logistic analysis suggested that hydrocephalus (odds ratio [OR] = 0.057, 95% confidence interval [CI] = 0.003–0.444; P = 0.018) and cistern involvement (OR = 0.100, 95% CI = 0.011–0.581; P = 0.017) were independent risk factors for poor short-term prognosis. Conclusion MRI can display the pathological changes of intracranial TB in detail; hydrocephalus and cistern involvement were independent risk factors for poor short-term prognosis.

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Section: Discussionmentioning

confidence: 99%

“…Early diagnosis and treatment is an important factor in improving the prognosis of patients with intracranial TB (9)(10)(11). The gold standard for the diagnosis of intracranial TB is positive CSF smear or culture (9). However, the positive rate of CSF diagnosis is low and time-consuming.…”

Section: Discussionmentioning

confidence: 99%

Relationship between magnetic resonance imaging findings and prognosis of intracranial tuberculosis

Yang

Wang

et al. 2021

Acta Radiol

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“…A characteristic T2W hypointense signal can be observed in caseating granulomas [ Figure 14 ], together with lipid peaks at 0.9 or 1.3 ppm on MRS mimicking lymphoma, but an absence of restricted diffusion will favor tuberculoma over lymphoma. [ 23 ] It is also useful to look for leptomeningeal enhancement in basal cisterns which can be commonly observed in intracranial tuberculous infection.…”

Section: Tuberculomasmentioning

confidence: 99%

“…The lesions usually have high or mixed signal intensity on T2-weighted and FLAIR images. [ 23 ] A dilemma exists when both entities present with multiple ring-enhancing lesions on CT or MRI. A pathognomonic sign called “eccentric target sign” (25% sensitive and 95% specific) on post-contrast CT or MRI has been described, which aids in the differentiation.…”

Section: Toxoplasmosismentioning

confidence: 99%

Different facets of intracranial central nervous system lymphoma and its imaging mimics

Kwok¹,

Li²,

Chan³

et al. 2022

JCIS

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Lymphomas of the central nervous system (CNS) are broadly classified into primary CNS lymphoma (PCNSL) and secondary CNS lymphoma (SCNSL). PCNSL refers to lymphoma restricted to the brain, leptomeninges, spinal cord, or eyes without evidence of it outside the CNS at primary diagnosis, while SCNSL refers to secondary CNS involvement by systemic lymphoma. The brain is the most common site of involvement and intracranial CNS lymphoma has a highly variable imaging appearance and varies according to the patient’s clinical profile and immunity. This pictorial essay aims to illustrate the different facets of intracranial CNS lymphomas on neuroimaging. This enables radiologists to be familiarized with their key diagnostic features and differentiate from their differential diagnoses, leading to early diagnosis, and treatment.

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“…Tuberculous brain abscess is a rare disorder seen in both immunocompetent and immunocompromised individuals (1,2) . For confirming true tuberculous abscess, presence of an abscess in the brain parenchyma, histology confirming vascular granulation tissue in the abscess wall and bacteriologic samples proving tuberculosis is required (3) .…”

Section: Introductionmentioning

confidence: 99%

Differentiating Pyogenic Brain Abscesses and Tuberculous using Magnetization Transfer MR Imaging and in Vivo Proton MR Spectroscopy

Islam¹,

Nighat²,

Firdous³

et al. 2022

PJMHS

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Objective: To find whether in vivo proton MR spectroscopy and magnetization transfer (MT) MR imaging can be used to differentiate between tuberculous brain abscess and pyogenic brain abscess. Study Design: Retrospective Place and duration: Radiology Department of Ibn_e_Sina Hospital Multan from January 2021 to January 2022. Methodology: The study included 15 subjects with brain abscesses who underwent in vivo MR spectroscopy, MT MR imaging and conventional MR imaging. Those with other systemic diseases were excluded. These techniques were also performed on 10 sex and age-matched control subjects for comparing MT ratios in normal and diseased parenchymal locations. 13 tuberculous abscesses were found in 4 patients, and 20 pyogenic abscesses were found in 11 patients. MT MR imaging and in vivo MR spectroscopy were used to evaluate suspected brain abscesses. Results: The mean MT ratio of the pyogenic brain abscesses was 25.55±1.60.MR spectroscopy showed that in pyogenic abscesses level of amino acids (valine, isoleucine, leucine) was 0.8 ppm and lipid and lactate was 1.2 ppm. Additionally, acetate, 1.91 ppm; glycine, 3.55 ppm; succinate,2.40 ppm and alanine, 1.47 pm were also seen. Four patients had 13 tuberculous abscesses. The mean MT ratio obtained from tuberculous abscesses was 19.87±1.54, which was significantly lower compared to the cortical grey matter, deep grey matter, white matter and pyogenic abscess (p<.001). Conclusion: MT ratios in tuberculous brain abscesses were lower than in pyogenic abscesses. In vivo, MR spectroscopy in pyogenic abscesses did not show amino acids. Tuberculous brain abscess can be differentiated from the pyogenic abscess by using both in vivo MR spectroscopy and MT MR imaging. Keywords: Pyogenic brain abscess, tuberculous brain abscess, MR spectroscopy

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MRI in intracranial tuberculosis: Have we seen it all?

Cited by 12 publications

References 52 publications

Relationship between magnetic resonance imaging findings and prognosis of intracranial tuberculosis

Relationship between magnetic resonance imaging findings and prognosis of intracranial tuberculosis

Different facets of intracranial central nervous system lymphoma and its imaging mimics

Differentiating Pyogenic Brain Abscesses and Tuberculous using Magnetization Transfer MR Imaging and in Vivo Proton MR Spectroscopy

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