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Absence of posterior pituitary bright spot in adults with CNS tuberculosis: A case-control study

Smitesh G G1, Pavithra Mannam2, Vignesh Kumar1

  • 1Department of General Medicine, Christian Medical College Vellore, Vellore, Tamil Nadu, India.

Plos One
|October 7, 2022
PubMed
Abstract

Insights

The absence of the posterior pituitary bright spot (PPBS) on MRI scans is strongly linked to Central Nervous System Tuberculosis (CNS TB). This finding can serve as a valuable diagnostic aid for CNS TB.

Area of Science:

  • Neurology
  • Radiology
  • Infectious Diseases

Background:

  • Diagnostic methods for Central Nervous System Tuberculosis (CNS TB) are challenged by its paucibacillary nature.
  • The posterior pituitary bright spot (PPBS) is a common finding on brain MRI in healthy individuals.
  • Absence of PPBS has been noted in pediatric CNS TB but not previously studied in adults.

Purpose of the Study:

  • To investigate the prevalence of absent PPBS in CNS TB patients compared to a control group.
  • To determine the association between the absence of PPBS and CNS TB.

Main Methods:

  • A retrospective case-control study involving 100 CNS TB patients and 200 controls.
  • MRI scans were reviewed by a blinded radiologist for the presence or absence of PPBS.
  • Statistical analysis was performed to assess the association between absent PPBS and CNS TB.

Main Results:

  • Absence of PPBS was significantly more common in CNS TB cases (47%) than in controls (8.5%), with an Odds Ratio of 7.90 (P<0.0001).
  • The finding demonstrated high specificity (91.5%) and a positive predictive value of 73.4%.
  • Including absent PPBS as a diagnostic feature increased the sensitivity for CNS TB detection from 77% to 84%.

Conclusions:

  • The absence of PPBS is significantly associated with CNS TB in adults.
  • Absent PPBS can serve as a simple and effective radiological aid in diagnosing CNS TB.

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