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Kulanthaivelu K, Jabeen S, Saini J, Raju S, Nalini A, Sadashiva N, Hegde S, Rolla NK, Saha I, M N, Vengalil S, Swaroop S, Rao S. Amide proton transfer imaging for differentiation of tuberculomas from high-grade gliomas: Preliminary experience. Neuroradiol J 2021; 34:440-448. [PMID: 33823712 DOI: 10.1177/19714009211002766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Tuberculomas can occasionally masquerade as high-grade gliomas (HGG). Evidence from magnetisation transfer (MT) imaging suggests that there is lower protein content in the tuberculoma microenvironment. Building on the principles of chemical exchange saturation transfer and MT, amide proton transfer (APT) imaging generates tissue contrast as a function of the mobile amide protons in tissue's native peptides and intracellular proteins. This study aimed to further the understanding of tuberculomas using APT and to compare it with HGG. METHOD Twenty-two patients (n = 8 tuberculoma; n = 14 HGG) were included in the study. APT was a 3D turbo spin-echo Dixon sequence with inbuilt B0 correction. A two-second, 2 μT saturation pulse alternating over transmit channels was applied at ±3.5 ppm around water resonance. The APT-weighted image (APTw) was computed as the MT ratio asymmetry (MTRasym) at 3.5 ppm. Mean MTRasym values in regions of interest (areas = 9 mm2; positioned in component with homogeneous enhancement/least apparent diffusion coefficient) were used for the analysis. RESULTS MTRasym values of tuberculomas (n = 14; 8 cases) ranged from 1.34% to 3.11% (M = 2.32 ± 0.50). HGG (n = 17;14 cases) showed MTRasym ranging from 2.40% to 5.70% (M = 4.32 ± 0.84). The inter-group difference in MTRasym was statistically significant (p < 0.001). APTw images in tuberculomas were notable for high MTRasym values in the perilesional oedematous-appearing parenchyma (compared to contralateral white matter; p < 0.001). CONCLUSION Tuberculomas demonstrate lower MTRasym ratios compared to HGG, reflective of a relative paucity of mobile amide protons in the ambient microenvironment. Elevated MTRasym values in perilesional parenchyma in tuberculomas are a unique observation that may be a clue to the inflammatory milieu.
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Affiliation(s)
- Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, India
| | - Shumyla Jabeen
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, India
| | - Sanita Raju
- Department of Neurology, National Institute of Mental Health and Neurosciences, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, India
| | | | | | | | - Netravathi M
- Department of Neurology, National Institute of Mental Health and Neurosciences, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, India
| | - Saikrishna Swaroop
- Department of Neurology, National Institute of Mental Health and Neurosciences, India
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, India
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Fatema K, Rahman MM, Akhter S, Akter N, Paul BC, Begum S, Begum F. Clinicoradiologic Profile and Outcome of Children With Tubercular Meningitis in a Tertiary Care Hospital in Bangladesh. J Child Neurol 2020; 35:195-201. [PMID: 31726924 DOI: 10.1177/0883073819884169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Children are most vulnerable to tubercular meningitis. Neuroimaging is an important initial investigation in tubercular meningitis. OBJECTIVE This study was done to describe the clinical profile, neuroimaging changes, and clinical outcome in children with tubercular meningitis. METHODOLOGY This was an observational cohort study on children with tubercular meningitis, between January 2012 and June 2018. Tubercular meningitis was diagnosed on the basis of clinical criteria, cerebrospinal fluid analysis, neuroimaging, and response to antitubercular drug treatment. Preferably magnetic resonance imaging (MRI) with contrast was done. RESULT Out of 79 pediatric patients, 17 patients were lost during follow-up; thus, a total of 62 patients were studied. Mean age at presentation was 7.040 (±3.99 SD) year, 51.6% children were male. Rural children were more affected. Twenty eight (45.2 patients had contact with a person with tuberculosis. Only 3 (4.8%) patients presented within 10 days of duration of illness. Most of the cases (67.7%) were in stage 2 at the time of diagnosis. The most common clinical feature was fever, seizure, and signs of meningeal irritation (all present in 12.9%). In neuroimaging most common findings were tuberculoma (50%), hydrocephalus (54.8%), and basal meningeal enhancement (33.8%). Regarding outcome, 6 (9.67%) patients expired and 47 (75%) patients had sequelae. The most common complications were hydrocephalus (30.64%) and intellectual disability (12.9 ). Hydrocephalus was the most common neuroimaging finding among the patients who expired (33%). CONCLUSION Hydrocephalus is the most common neuroimaging finding. Normal neuroimaging is associated with good outcome whereas all the patients who died had abnormal neuroimaging.
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Affiliation(s)
- Kanij Fatema
- Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Mizanur Rahman
- Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shaheen Akhter
- Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Naznin Akter
- Department of Pediatrics, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Bikush Chandra Paul
- Medical Officer, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Suraiya Begum
- Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Fahmida Begum
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Marais S, Van Toorn R, Chow FC, Manesh A, Siddiqi OK, Figaji A, Schoeman JF, Meintjes G. Management of intracranial tuberculous mass lesions: how long should we treat for? Wellcome Open Res 2020; 4:158. [PMID: 32047859 PMCID: PMC6996525 DOI: 10.12688/wellcomeopenres.15501.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2020] [Indexed: 12/15/2022] Open
Abstract
Tuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response is unpredictable, with lesions frequently enlarging paradoxically or persisting for many years despite appropriate TB treatment and corticosteroid therapy. Most international guidelines recommend a 9-12 month course of TB treatment for central nervous system TB when the infecting Mycobacterium tuberculosis ( M.tb) strain is sensitive to first-line drugs. However, there is variation in opinion and practice with respect to the duration of TB treatment in patients with tuberculomas or tuberculous abscesses. A major reason for this is the lack of prospective clinical trial evidence. Some experts suggest continuing treatment until radiological resolution of enhancing lesions has been achieved, but this may unnecessarily expose patients to prolonged periods of potentially toxic drugs. It is currently unknown whether persistent radiological enhancement of intracranial tuberculomas after 9-12 months of treatment represents active disease, inflammatory response in a sterilized lesion or merely revascularization. The consequences of stopping TB treatment prior to resolution of lesional enhancement have rarely been explored. These important issues were discussed at the 3 rd International Tuberculous Meningitis Consortium meeting. Most clinicians were of the opinion that continued enhancement does not necessarily represent treatment failure and that prolonged TB therapy was not warranted in patients presumably infected with M.tb strains susceptible to first-line drugs. In this manuscript we highlight current medical treatment practices, benefits and disadvantages of different TB treatment durations and the need for evidence-based guidelines regarding the treatment duration of patients with intracranial tuberculous mass lesions.
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Affiliation(s)
- Suzaan Marais
- Department of Neurology, Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, 4091, South Africa
- Division of Neurology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, 7925, South Africa
| | - Ronald Van Toorn
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, 7505, South Africa
| | - Felicia C. Chow
- Weill Institute of Neurosciences and Department of Neurology and Division of Infectious Diseases, University of California, San Francisco, California, 94110, USA
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004, India
| | - Omar K. Siddiqi
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, 02215, USA
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Anthony Figaji
- Division of Neurosurgery and Neuroscience institute, University of Cape Town, Cape Town, 7700, South Africa
| | - Johan F. Schoeman
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, 7505, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Department of Medicine, University of Cape Town, Cape Town, 7925, South Africa
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Marais S, Van Toorn R, Chow FC, Manesh A, Siddiqi OK, Figaji A, Schoeman JF, Meintjes G. Management of intracranial tuberculous mass lesions: how long should we treat for? Wellcome Open Res 2019; 4:158. [PMID: 32047859 PMCID: PMC6996525 DOI: 10.12688/wellcomeopenres.15501.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 12/15/2022] Open
Abstract
Tuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response is unpredictable, with lesions frequently enlarging paradoxically or persisting for many years despite appropriate TB treatment and corticosteroid therapy. Most international guidelines recommend a 9-12 month course of TB treatment for central nervous system TB when the infecting Mycobacterium tuberculosis ( M.tb) strain is sensitive to first-line drugs. However, there is variation in opinion and practice with respect to the duration of TB treatment in patients with tuberculomas or tuberculous abscesses. A major reason for this is the lack of prospective clinical trial evidence. Some experts suggest continuing treatment until radiological resolution of enhancing lesions has been achieved, but this may unnecessarily expose patients to prolonged periods of potentially toxic drugs. It is currently unknown whether persistent radiological enhancement of intracranial tuberculomas after 9-12 months of treatment represents active disease, inflammatory response in a sterilized lesion or merely revascularization. The consequences of stopping TB treatment prior to resolution of lesional enhancement have rarely been explored. These important issues were discussed at the 3 rd International Tuberculous Meningitis Consortium meeting. Most clinicians were of the opinion that continued enhancement does not necessarily represent treatment failure and that prolonged TB therapy was not warranted in patients presumably infected with M.tb strains susceptible to first-line drugs. In this manuscript we highlight current medical treatment practices, benefits and disadvantages of different TB treatment durations and the need for evidence-based guidelines regarding the treatment duration of patients with intracranial tuberculous mass lesions.
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Affiliation(s)
- Suzaan Marais
- Department of Neurology, Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, 4091, South Africa
- Division of Neurology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, 7925, South Africa
| | - Ronald Van Toorn
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, 7505, South Africa
| | - Felicia C. Chow
- Weill Institute of Neurosciences and Department of Neurology and Division of Infectious Diseases, University of California, San Francisco, California, 94110, USA
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004, India
| | - Omar K. Siddiqi
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, 02215, USA
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Anthony Figaji
- Division of Neurosurgery and Neuroscience institute, University of Cape Town, Cape Town, 7700, South Africa
| | - Johan F. Schoeman
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, 7505, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Department of Medicine, University of Cape Town, Cape Town, 7925, South Africa
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Marais S, Van Toorn R, Chow FC, Manesh A, Siddiqi OK, Figaji A, Schoeman JF, Meintjes G. Management of intracranial tuberculous mass lesions: how long should we treat for? Wellcome Open Res 2019. [DOI: 10.12688/wellcomeopenres.15501.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Tuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response is unpredictable, with lesions frequently enlarging paradoxically or persisting for many years despite appropriate TB treatment and corticosteroid therapy. Most international guidelines recommend a 9-12 month course of TB treatment for central nervous system TB when the infecting Mycobacterium tuberculosis (M.tb) strain is sensitive to first-line drugs. However, there is variation in opinion and practice with respect to the duration of TB treatment in patients with tuberculomas or tuberculous abscesses. A major reason for this is the lack of prospective clinical trial evidence. Some experts suggest continuing treatment until radiological resolution of enhancing lesions has been achieved, but this may unnecessarily expose patients to prolonged periods of potentially toxic drugs. It is currently unknown whether persistent radiological enhancement of intracranial tuberculomas after 9-12 months of treatment represents active disease, inflammatory response in a sterilized lesion or merely revascularization. The consequences of stopping TB treatment prior to resolution of lesional enhancement have rarely been explored. These important issues were discussed at the 3rd International Tuberculous Meningitis Consortium meeting. Most clinicians were of the opinion that continued enhancement does not necessarily represent treatment failure and that prolonged TB therapy was not warranted in patients presumably infected with M.tb strains susceptible to first-line drugs. In this manuscript we highlight current medical treatment practices, benefits and disadvantages of different TB treatment durations and the need for evidence-based guidelines regarding the treatment duration of patients with intracranial tuberculous mass lesions.
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Soni N, Srindharan K, Kumar S, Mishra P, Bathla G, Kalita J, Behari S. Arterial spin labeling perfusion: Prospective MR imaging in differentiating neoplastic from non-neoplastic intra-axial brain lesions. Neuroradiol J 2018; 31:544-553. [PMID: 29890916 DOI: 10.1177/1971400918783058] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The purpose of this article is to assess the diagnostic performance of arterial spin-labeling (ASL) magnetic resonance perfusion imaging to differentiate neoplastic from non-neoplastic brain lesions. MATERIAL AND METHODS This prospective study included 60 consecutive, newly diagnosed, untreated patients with intra-axial lesions with perilesional edema (PE) who underwent clinical magnetic resonance imaging including ASL sequences at 3T. Region of interest analysis was performed to obtain mean cerebral blood flow (CBF) values from lesion (L), PE and normal contralateral white matter (CWM). Normalized (n) CBF ratio was obtained by dividing the mean CBF value of L and PE by mean CBF value of CWM. Discriminant analyses were performed to determine the best cutoff value of nCBFL and nCBFPE in differentiating neoplastic from non-neoplastic lesions. RESULTS Thirty patients were in the neoplastic group (15 high-grade gliomas (HGGs), 15 metastases) and 30 in the non-neoplastic group (12 tuberculomas, 10 neurocysticercosis, four abscesses, two fungal granulomas and two tumefactive demyelination) based on final histopathology and clincoradiological diagnosis. We found higher nCBFL (6.65 ± 4.07 vs 1.68 ± 0.80, p < 0.001) and nCBFPE (1.86 ± 1.43 vs 0.74 ± 0.21, p < 0.001) values in the neoplastic group than non-neoplastic. For predicting neoplastic lesions, we found an nCBFL cutoff value of 1.89 (AUC 0.917; 95% CI 0.854 to 0.980; sensitivity 90%; specificity 73%) and nCBFPE value of 0.76 (AUC 0.783; 95% CI 0.675 to 0.891; sensitivity 80%; specificity 58%). Mean nCBFL was higher in HGGs (8.70 ± 4.16) compared to tuberculomas (1.98 ± 0.87); and nCBFPE was higher in HGGs (3.06 ± 1.53) compared to metastases (0.86 ± 0.34) and tuberculomas (0.73 ± 0.22) ( p < 0.001). CONCLUSION ASL perfusion may help in distinguishing neoplastic from non-neoplastic brain lesions.
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Affiliation(s)
- Neetu Soni
- 1 Neuroradiology Department, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Karthika Srindharan
- 2 Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Sunil Kumar
- 2 Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- 3 Department of Biostatistics and Health Informatics, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Girish Bathla
- 1 Neuroradiology Department, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jyantee Kalita
- 4 Department of Neurology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- 5 Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
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Barnes SL, Quarles CC, Yankeelov TE. Modeling the effect of intra-voxel diffusion of contrast agent on the quantitative analysis of dynamic contrast enhanced magnetic resonance imaging. PLoS One 2014; 9:e108726. [PMID: 25275536 PMCID: PMC4183533 DOI: 10.1371/journal.pone.0108726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/02/2014] [Indexed: 01/22/2023] Open
Abstract
Quantitative dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) provides estimates of physiologically relevant parameters related to tissue blood flow, vascular permeability, and tissue volume fractions which can then be used for prognostic and diagnostic reasons. However, standard techniques for DCE-MRI analysis ignore intra-voxel diffusion, which may play an important role in contrast agent distribution and voxel signal intensity and, thus, will affect quantification of the aforementioned parameters. To investigate the effect of intra-voxel diffusion on quantitative DCE-MRI, we developed a finite element model of contrast enhancement at the voxel level. For diffusion in the range of that expected for gadolinium chelates in tissue (i.e., 1×10−4 to 4×10−4 mm2/s), parameterization errors range from −58% to 12% for Ktrans, −9% to 8% for ve, and −60% to 213% for vp over the range of Ktrans, ve, vp, and temporal resolutions investigated. Thus the results show that diffusion has a significant effect on parameterization using standard techniques.
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Affiliation(s)
- Stephanie L. Barnes
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, United States of America
| | - C. Chad Quarles
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Physics and Astronomy, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee, United States of America
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, United States of America
- Program in Chemical and Physical Biology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Thomas E. Yankeelov
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Physics and Astronomy, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee, United States of America
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, United States of America
- Program in Chemical and Physical Biology, Vanderbilt University, Nashville, Tennessee, United States of America
- * E-mail:
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Affiliation(s)
- Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rakesh K Gupta
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, Haryana, India.
| | - Krishan K Jain
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, Haryana, India
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Abstract
Tuberculosis (TB) has shown a resurgence in nonendemic populations in recent years and accounts for 8 million deaths annually in the world. Central nervous system involvement is one of the most serious forms of this infection, acting as a prominent cause of morbidity and mortality in developing countries. The rising number of cases in developed countries is mostly attributed to factors such as the pandemic of acquired immunodeficiency syndrome and increased migration in a globalized world. Mycobacterium TB is responsible for almost all cases of tubercular infection in the central nervous system. It can manifest in a variety of forms as tuberculous meningitis, tuberculoma, and tubercular abscess. Spinal infection may result in spondylitis, arachnoiditis, and/or focal intramedullary tuberculomas. Timely diagnosis of central nervous system TB is paramount for the early institution of appropriate therapy, because delayed treatment is associated with severe morbidity and mortality. It is therefore important that physicians and radiologists understand the characteristic patterns, distribution, and imaging manifestations of TB in the central nervous system. Magnetic resonance imaging is considered the imaging modality of choice for the study of patients with suspected TB. Advanced imaging techniques including magnetic resonance perfusion and diffusion tensor imaging may be of value in the objective assessment of therapy and to guide the physician in the modulation of therapy in these patients.
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Affiliation(s)
- Carlos Torres
- From the *Department of Radiology, The Ottawa Hospital Civic and General Campus, University of Ottawa, Ottawa, Ontario, Canada; †Department of Radiology, The University of Texas Medical Branch, Galveston, TX; ‡Medical College of Georgia, Georgia Regents University, Martinez, GA; and §Department of Radiology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
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Sankhe S, Baheti A, Ihare A, Mathur S, Dabhade P, Sarode A. Perfusion magnetic resonance imaging characteristics of intracerebral tuberculomas and its role in differentiating tuberculomas from metastases. Acta Radiol 2013; 54:307-12. [PMID: 23319719 DOI: 10.1258/ar.2012.120347] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intracerebral tuberculomas usually manifest as ring-enhancing of nodular lesions on magnetic resonance imaging (MRI). These imaging findings are also observed in other lesions like metastases and toxoplasmosis. PURPOSE To study the MRI perfusion characteristics of tuberculomas and its potential role in their definitive diagnosis. MATERIAL AND METHODS Thirty-four tuberculomas were evaluated by conventional and perfusion MRI. The relative cerebral blood volume (rCBV) values of the center, peripheral wall, and perilesional neuroparenchymal tissue were calculated using rCBV maps. Ten ring-enhancing metastases were similarly evaluated and rCBV values of their peripheral walls were calculated. RESULTS Thirty-one of the 34 tuberculomas were ring-enhancing or conglomerate lesions and revealed hypoperfused centers with hyperperfused peripheral walls, with the mean rCBV ± SD being 0.42 ± 0.25 and 2.04 ± 0.61, respectively. Three nodular enhancing lesions showed predominantly homogenous hyperperfusion, with the mean rCBV measuring 2.96 ± 0.39 (mean ± SD). The perilesional neuroparenchyma was hypoperfused in both cases. The metastases revealed mean rCBV ratio of the peripheral wall to be 5.43 ± 2.1 (mean ± SD). Analysis of the values by ROC curve method revealed a cut-off value of ≥3.745 for differentiating ring-enhancing metastases from ring-enhancing tuberculomas. CONCLUSION Perfusion MR is a useful tool for the assessment of tuberculomas and can help differentiate them from neoplasms like metastases. It also has a potential role in monitoring therapy and for early detection of drug resistance.
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Affiliation(s)
- Shilpa Sankhe
- Department of Radiology, Seth GS Medical College and KEM Hospital, Thane, India
| | - Akshay Baheti
- Department of Radiology, Seth GS Medical College and KEM Hospital, Thane, India
| | - Ashish Ihare
- Department of Radiology, Seth GS Medical College and KEM Hospital, Thane, India
| | - Shobhit Mathur
- Department of Radiology, Seth GS Medical College and KEM Hospital, Thane, India
| | - Poonam Dabhade
- Department of Radiology, Seth GS Medical College and KEM Hospital, Thane, India
| | - Ashish Sarode
- Department of Radiology, Seth GS Medical College and KEM Hospital, Thane, India
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Husain N, Kumar P. Pathology of tropical diseases. Neuroimaging Clin N Am 2011; 21:757-75, vii. [PMID: 22032498 DOI: 10.1016/j.nic.2011.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Tropical diseases affecting the central nervous system include infections, infestations, and nutritional deficiency disorders. This article discusses the commonly encountered diseases. The infections include bacterial, mycobacterial, fungal, parasitic, and viral infections with varied clinical manifestations. Imaging sensitivity and specificity for the prediction of the cause of infections has improved with application of advanced techniques. Microbial demonstration and histology remain the gold standard for diagnosis. Understanding the basis of imaging changes is mandatory for better evaluation of images. Nutritional disorders present with generalized and nonspecific imaging manifestations. The pathology of commonly encountered vitamin deficiencies is also discussed.
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Affiliation(s)
- Nuzhat Husain
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, Uttar Pradesh, India.
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Abstract
Tuberculosis (TB) in any form is a devastating disease, which in its most severe form involves the central nervous system (CNS), with a high mortality and morbidity. Early diagnosis of CNS TB is necessary for appropriate treatment to reduce this morbidity and mortality. Routine diagnostic techniques involve culture and immunological tests of the tissue and biofluids, which are time-consuming and may delay definitive management. Noninvasive imaging modalities such as computed tomography (CT) scan and magnetic resonance imaging (MRI) are routinely used in the diagnosis of neurotuberculosis, with MRI offering greater inherent sensitivity and specificity than CT scan. In addition to conventional MRI imaging, magnetization transfer imaging, diffusion imaging, and proton magnetic resonance spectroscopy techniques are also being evaluated for better tissue characterization in CNS TB. The current article reviews the role of various MRI techniques in the diagnosis and management of CNS TB.
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Affiliation(s)
- Richa Trivedi
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014, UP, India
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Abstract
The evaluation of blood-brain barrier (BBB) integrity with contrast-enhanced magnetic resonance imaging (MRI) may prove valuable in the setting of certain brain pathologies, such as brain tumors and acute ischemic stroke. Various MRI protocols have been developed to explore the integrity of the BBB by monitoring the leakage of intravenously administered contrast medium into the brain parenchyma. In its simplest form, BBB integrity is assessed qualitatively, by determining the presence or absence of contrast-enhancement on a structural MR image. When a dynamic contrast-enhanced (DCE) MRI protocol is combined with a suitable pharmacokinetic model, DCE-MRI can map the spatial distribution of BBB integrity throughout the brain and assist with evaluating the effects of therapy. Several model-free surrogate measures of BBB permeability have been recently proposed, all of which can be readily computed from standard dynamic susceptibility contrast MRI perfusion scans. Contrast-enhanced MRI offers multiple strategies for evaluating BBB integrity.
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Affiliation(s)
- Andrea Kassner
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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Yadav A, Chaudhary C, Keshavan AH, Agarwal A, Verma S, Prasad KN, Rathore RKS, Trivedi R, Gupta RK. Correlation of CSF proinflammatory cytokines with MRI in tuberculous meningitis. Acad Radiol 2010; 17:194-200. [PMID: 20004599 DOI: 10.1016/j.acra.2009.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 08/26/2009] [Accepted: 09/10/2009] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES To demonstrate the correlation of proinflammatory cytokines (PCs), intercellular adhesion molecule (sICAM-1), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1beta (IL-1beta) in CSF of tuberculous meningitis (TBM) patients with magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) and also to look for the changes in imaging parameters after antitubercular treatment (ATT) in these patients. MATERIALS AND METHODS Forty patients with TBM (median age, 27.7 years) and 30 age-/sex-matched controls were included in this study. PCs were quantified from the CSF of TBM patients at the time of hospital admission (baseline). MRI including DTI was performed at the time of baseline study and 6 months after ATT. RESULTS Significant positive correlation of PCs with fractional anisotropy (FA) values and post-contrast signal intensity (PCSI) collected from cerebral cortical regions was observed in TBM patients. A significant positive correlation of FA values with PCSI was also observed at both time points in patient groups. At baseline study significantly high FA values were observed in patients compared to controls. Significantly decreased FA values and PCSI were observed in the patients after 6 months of ATT compared to the baseline study. CONCLUSIONS Results of this study suggest that the DTI-derived anisotropy have the potential to delineate meningeal inflammation and it may be used in assessment of therapeutic response in TBM patients as an additional method to conventional imaging.
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Affiliation(s)
- Abhishek Yadav
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226014, India
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Vidarsson L, Thornhill RE, Liu F, Mikulis DJ, Kassner A. Quantitative permeability magnetic resonance imaging in acute ischemic stroke: how long do we need to scan? Magn Reson Imaging 2009; 27:1216-22. [PMID: 19695816 DOI: 10.1016/j.mri.2009.01.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 12/09/2008] [Accepted: 01/26/2009] [Indexed: 11/26/2022]
Abstract
Blood-brain barrier (BBB) permeability estimation with dynamic contrast-enhanced MRI (DCE-MRI) has shown significant potential for predicting hemorrhagic transformation (HT) in patients presenting with acute ischemic stroke (AIS). In this work, the effects of scan duration on quantitative BBB permeability estimates (KPS) were investigated. Data from eight patients (three with HT) aged 37-93 years old were retrospectively studied by directly calculating the standard deviation of KPS as a function of scan time. The uncertainty in KPS was reduced only slightly for a scan time of 3 min and 30 s (4% reduction in P value from .047 to .045). When more than 3 min and 30 s of data were used, quantitative permeability MRI was able to separate those patients who proceeded to HT from those who did not (P value <.05). Our findings indicate that reducing permeability acquisition times is feasible in keeping with the need to maintain time-efficient MR protocols in the setting of AIS.
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Affiliation(s)
- Logi Vidarsson
- Department of Diagnostic Imaging, The Hospital for Sick Children and The University of Toronto, Toronto, ON, Canada.
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Haris M, Husain N, Singh A, Awasthi R, Singh Rathore RK, Husain M, Gupta RK. Dynamic contrast-enhanced (DCE) derived transfer coefficient (ktrans) is a surrogate marker of matrix metalloproteinase 9 (MMP-9) expression in brain tuberculomas. J Magn Reson Imaging 2008; 28:588-97. [DOI: 10.1002/jmri.21491] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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