Tuberculoma - a great mimicker: can diffusion tensor imaging and tractography help?

Area of Science:

• Neuroimaging
• Radiology
• Infectious Diseases

Background:

• Central nervous system (CNS) tuberculomas present diagnostic challenges, often mimicking tumors on conventional imaging.
• Distinguishing tuberculomas from tumors typically requires invasive tissue sampling.
• Diffusion tensor imaging (DTI) offers advanced characterization of molecular diffusion and white matter involvement.

Purpose of the Study:

• To quantify diffusion tensor changes in brain tuberculomas.
• To assess white matter involvement patterns using 3D tractography.

Main Methods:

• Thirty patients with brain tuberculomas underwent 3-T MRI with DTI.
• Regions of interest were analyzed for fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values.
• 3D tractography was employed to visualize white matter pathways.

Main Results:

• Significantly different FA and ADC values were observed in tuberculoma centers and perilesional areas compared to the contralateral hemisphere.
• Tractography demonstrated interrupted white fibers centrally and deviated fibers peripherally.
• No infiltration of white matter, typical of tumors, was observed.

Conclusions:

• DTI reveals significant qualitative and quantitative changes in tuberculomas and surrounding areas.
• Tractography patterns in tuberculomas differ from those seen in infiltrating tumors.
• These DTI-based findings may assist in differentiating tuberculomas from tumors.