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Contrast medium-enhanced MRI findings and changes over time in stage I tuberculous meningitis

I Oztoprak1, C Gümüs, B Oztoprak

  • 1Department of Radiology Cumhuriyet University Faculty of Medicine, 58140 Sivas, Turkey. oztoprak@cumhuriyet.edu.tr

Clinical Radiology
|November 6, 2007
PubMed
Abstract

Insights

Early tuberculous meningitis (TBM) shows diffuse meningeal enhancement on MRI, which later shifts to focal patterns, predominantly in basal areas. This imaging characteristic helps in diagnosing TBM.

Area of Science:

  • Neurology
  • Radiology
  • Infectious Diseases

Background:

  • Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis.
  • Early diagnosis and treatment of TBM are crucial for patient outcomes.
  • Magnetic resonance imaging (MRI) plays a vital role in diagnosing TBM.

Purpose of the Study:

  • To detail the imaging characteristics of early tuberculous meningitis (TBM).
  • To observe the evolution of TBM imaging findings over time.
  • To analyze patterns on gadolinium-enhanced, T1-weighted MRI.

Main Methods:

  • Retrospective analysis of 26 patients with early TBM.
  • Evaluation of contrast-enhanced, T1-weighted, spin-echo MRI scans.
  • Categorization of meningeal enhancement by distribution and pattern (diffuse, focal, linear, nodular, mixed).

Main Results:

  • Diffuse meningeal enhancement was observed in 35% of patients.
  • Focal meningeal enhancement was present in 65% of cases.
  • Focal enhancement predominantly occurred in basal pial areas, especially the interpeduncular fossa. Six patients with initial diffuse enhancement later showed focal patterns.

Conclusions:

  • Early TBM exhibits reactive diffuse meningeal enhancement on contrast-enhanced T1-weighted MRI.
  • Meningeal enhancement in TBM typically evolves to a focal pattern, concentrating in basal regions over time.

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