Quantitative ASL Perfusion and Vessel Wall MRI in Tuberculous Meningitis: A Pre- and Post-Treatment Study

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Tuberculous meningitis (TBM) is a severe CNS infection.
• TBM can cause cerebral vasculitis and infarction.
• Evaluating treatment effects on TBM-related vascular changes is crucial.

Purpose of the Study:

• To assess cerebral perfusion and vasculitis changes in TBM patients before and after treatment using MRI.
• To compare infarcted and non-infarcted brain regions with controls.
• To correlate imaging findings with clinical TBM severity.

Main Methods:

• Quantitative arterial spin labeling (ASL) perfusion MRI.
• Black-blood vessel wall MRI.
• Comparison of TBM patients (n=73) and controls (n=26) at diagnosis and post-treatment.

Main Results:

• Reduced cerebral blood flow (CBF) was observed in infarcted and non-infarcted TBM brain regions compared to controls.
• Vasculitis was prevalent in TBM patients, primarily affecting anterior circulation.
• Post-treatment, CBF significantly increased in non-infarcted regions, correlating with TBM stage and vasculitis severity.

Conclusions:

• TBM infarcts show significant hypoperfusion, while non-infarcted areas exhibit reversible ischemia.
• ASL and vessel wall imaging are valuable tools for monitoring TBM treatment response.
• These MRI techniques can help predict late-stage infarction in TBM patients.