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160 - Tuberculoma

from Section 6 - Primarily Intra-Axial Masses

Published online by Cambridge University Press:  05 August 2013

Mauricio Castillo
Affiliation:
University of North Carolina School of Medicine
Zoran Rumboldt
Affiliation:
Medical University of South Carolina
Mauricio Castillo
Affiliation:
University of North Carolina, Chapel Hill
Benjamin Huang
Affiliation:
University of North Carolina, Chapel Hill
Andrea Rossi
Affiliation:
G. Gaslini Children's Research Hospital
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Summary

Specific Imaging Findings

Tuberculomas are ring-enhancing lesions that vary in size significantly from less than a centimeter to several centimeters in size. Although they are commonly found in the cerebral hemispheres, they may occur anywhere in the brain including the cerebellum and brainstem. On CT the lesion density varies and is surrounded by variable degrees of vasogenic edema. There is contrast enhancement of the capsule, while calcifications are seen in about 20% of tuberculomas. Occasionally the central aspect of the lesion contains an enhancing nodule or calcification giving rise to the so-called “target” sign, which is highly suggestive of tuberculoma. On MRI, tuberculomas with a necrotic center show low T1 and high T2 signal intensities, while those with a solid center show intermediate T1 and low T2 signal, along with low ADC values. Thick adjacent meningeal enhancement suggests the diagnosis. Thus an abscess-like lesion with low T2 centrally suggests tuberculosis or fungus. On magnetization transfer T1-weighted images the capsule is characteristically hyperintense. MRS findings show increased levels of lipids and lactate, low NAA and creatine with variable levels of choline, but no amino acids that are present in pyogenic abscess. Perfusion studies show low rCBV. Infarcts are common, especially in the “tubercular zone” – caudate nucleus, anterior thalamus, and anterior internal capsule.

Type
Chapter
Information
Brain Imaging with MRI and CT
An Image Pattern Approach
, pp. 331 - 332
Publisher: Cambridge University Press
Print publication year: 2012

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References

1. Kim, TK, Chang, KH, Kim, CJ, Goo, JM, et al.Intracranial tuberculoma: comparison of MR with pathologic findings. AJNR 1995;16:1903–8.Google ScholarPubMed
2. Gupta, RK, Vatsal, DK, Husain, N, Chawla, S, et al.Differentiation of tuberculous from pyogenic brain abscesses with in vivo proton MR spectroscopy and magnetization transfer MR imaging. AJNR 2001;22:1503–9.Google ScholarPubMed
3. Saxena, S, Prakash, M, Kumar, S, Gupta, RK. Comparative evaluation of magnetization transfer contrast and fluid attenuated inversion recovery sequences in brain tuberculoma. Clin Radiol 2005;60:787–93.CrossRefGoogle ScholarPubMed
4. Gupta, RK, Husain, M, Vatsal, DK, et al.Comparative evaluation of magnetization transfer MR imaging and in-vivo proton MR spectroscopy in brain tuberculomas. Magn Reson Imaging 2002;20:375–81.CrossRefGoogle ScholarPubMed
5. Haris, M, Gupta, RK, Husain, M, et al.Assessment of therapeutic response in brain tuberculomas using serial dynamic contrast-enhanced MRI. Clin Radiol 2008;63:562–74.CrossRefGoogle ScholarPubMed

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