Peripheral blood CD4⁺ T-lymphocyte count as a predictor of MRI findings in intracranial parenchymal tuberculomas

This study aims to evaluate the association between peripheral blood CD4⁺ T-lymphocyte count and magnetic resonance imaging (MRI) features of intracranial parenchymal tuberculomas in patients diagnosed with hematogenous disseminated pulmonary tuberculosis.

A retrospective analysis was conducted on patients diagnosed with hematogenous disseminated pulmonary tuberculosis accompanied by intracranial parenchymal tuberculomas. Patients were categorized into two groups based on MRI findings: those demonstrating perilesional edema (edematous type) and those without (non-edematous type). Demographic data, clinical symptoms, peripheral blood T-lymphocyte subsets, and additional MRI features were compared between the two groups.

Among 144 patients included in the analysis, 56 were classified into the edematous group and 88 into the non-edematous group. The frequency of headache was higher in the edematous group (60.7%) compared to the non-edematous group (40.9%). The median age was lower in the edematous group [27.0 years (IQR: 20.8, 42.0)] relative to the non-edematous group [33.5 years (IQR: 24.0, 51.0)]. A higher proportion of female patients was also observed in the edematous group (55.4%), compared to the non-edematous group (35.2%). Univariate analysis indicated that female sex, elevated peripheral blood CD3⁺ T-lymphocyte count, and elevated CD4⁺ T-lymphocyte count were significantly associated with the presence of perilesional edema [Odds ratio (OR) = 2.28 (95% Confidence Interval (CI): 1.15-4.522); OR = 1.001 (95% CI: 1.000-1.002); OR = 1.002 (95% CI: 1.000-1.003)], respectively. In multivariate analysis, elevated CD4⁺ T-lymphocyte count remained an independent predictor of perilesional edema [OR = 1.001 (95% CI: 1.000-1.002)]. On contrast-enhanced MRI, ring-enhancing lesions were more frequently observed in the edematous group (76.8%), compared to the non-edematous group (25%).

In patients with hematogenous disseminated pulmonary tuberculosis and concurrent intracranial tuberculomas, higher peripheral CD4 + T-lymphocyte counts are independently associated with the presence of perilesional edema and a greater likelihood of ring-like enhancement on MRI.