Magnetic Resonance Imaging in Intracranial Tuberculosis – An Observational Study from Mangalore, India

Abstract

BACKGROUND Intracranial tuberculosis is one of the more severe forms of TB and an important cause of morbidity and mortality in affected individuals. It comprises 10 % of total tuberculosis cases and 20 % among immunocompromised patients. Contrastenhanced magnetic resonance imaging (MRI) is the imaging modality of choice, as it helps in its early diagnosis and to assess the complications of intracranial tuberculosis thereby reducing the morbidity and the mortality of the disease. The main objectives of this article were to revisit the spectrum of involvement and assess the tubercular lesions on MRI, determine the various presentations of intracranial tuberculosis and its associated complications. METHODS This is a single-center, hospital based, observational and retrospective study. The study included 25 patients who had proven intracranial tuberculosis and underwent MR examination of the brain from March 2015 to April 2020. All patients had been referred to the Department of Radiodiagnosis with clinical suspicion of intracranial pathology. The various manifestations and their complications were evaluated. RESULTS This present study comprised 15 males (60 %) and 10 females (40 %), having a male to female ratio of 1.5:1. The most common age group was 21 – 40 years and 51 – 60 years with a range of 16 – 68 years. The 25 cases diagnosed with intracranial TB had a varied presentation. The most common presentation was isolated tuberculoma 15 (60 %) followed by mixed presentation 7 (28 %). Complications were seen in 5 (20 %), which included hydrocephalus, ventriculitis and infarcts. CONCLUSIONS Contrast enhanced MRI is the established modality of choice to diagnose and monitor intracranial tuberculosis. Good knowledge of its various imaging characteristics and spectrum of involvement helps in the diagnosis and management. KEY WORDS Tuberculosis, MRI, Tuberculoma