Central nervous system tuberculosis: MRI
Tóm tắt
The MRI findings of 18 proven cases of central nervous system (CNS) tuberculosis were reviewed; 10 patients were seropositive for HIV. All had medical, laboratory, or surgical proof of CNS tuberculosis. Eleven patients had meningitis, of whom two also had arachnoiditis. Five patients had focal intra-axial tuberculomas: four brain masses and one an intramedullary spinal lesion. Two patients had focal extra-axial tuberculomas: one in the pontine cistern, and one in the spine. In all 11 patients with meningitis MRI showed diffuse, thick, meningeal enhancement. All intraparenchymal tuberculomas showed low signal intensity on T2-weighted images and ring or nodular enhancement. The extra-axial tuberculomas had areas isointense or hypoitense relative to normal brain and spinal cord on T2-weighted images. Although tuberculous meningitis cannot be differentiated from other meningitides on the basis of MR findings, intraparenchymal tuberculomas show characteristic T2 shortening, not found in most other space-occupying lesions. In the appropriate clinical setting, tuberculoma should be considered.
Tài liệu tham khảo
Dastur DK (1983) Neurosurgically relevant aspects of pathology and pathogenesis of intracranial and intraspinal tuberculosis. Neurosurg Rev 6:103–110
Talamás O, Del Brutto H, Garcia-Ramos G (1989) Brain-stem tuberculoma: an analysis of 11 patients. Arch Neurol 46:529–535
Venger BH, Dion FM, Rouah E, Handel SF (1987) MR imaging of pontine tuberculoma (case report). AJNR 8:1149–1150
Jena A, Banerji AK, Tripathi RP, et al (1991) Demonstration of intramedullary tuberculomas by magnetic resonance imaging: a report of two cases. Br J Radiol 64:555–557
Gupta RK, Jena A, Sharma A, Guha DK, Khushu S, Gupta AK (1988) MR imaging of intracranial tuberculomas. J Comput Assist Tomogr 12:280–285
Choksey MS, Powell M, Gibb WRG, Casey ATH, Geddes JF (1989) A conus tuberculoma mimicking an intramedullary tumour: a case report and review of the literature. Br J Neurosurg 3:117–122
Salgado P, Del Brutto OH, Talams O, Zenteno MA, Rodriguez-Carbajal J (1989) Intracranial tuberculoma: MR imaging. Neuroradiology 31:299–302
Rhoton EL, Ballinger WE, Quisling R, Sypert GW (1988) Intramedullary spinal tuberculoma. Neurosurgery 22:733–736
Chang KH, Han MH, Roh JK, et al (1990) Gd-DTPA enhanced MR imaging in intracranial tuberculosis. Neuroradiology 32: 19–25
Dastur HM (1983) Diagnosis and neurosurgical treatment of tuberculous disease of the CNS. Neurosurgery 6:111–117
Goldberg G (1983) Tuberculous infections of the central nervous system. Arizona Med 167–169