Child's Nervous System

, Volume 25, Issue 8, pp 941–947 | Cite as

MRI to demonstrate diagnostic features and complications of TBM not seen with CT

  • Manana Pienaar
  • Savvas Andronikou
  • Ronald van Toorn
Original Paper



Computed tomography (CT) findings in children with tuberculous meningitis (TBM) often do not explain the clinical presentation and may even be normal. Magnetic resonance imaging (MRI) has the potential to diagnose TBM with greater sensitivity than CT and also to detect more infarcts.


The aim of this study was to determine whether MRI demonstrates features and complications of TBM not present on CT.

Materials and methods

Retrospective, blinded evaluation and comparison of CT and MRI findings in children with TBM were performed.


Of 30 children included, MRI demonstrated eight more with basal enhancement and four more with infarctions. Overall, MRI demonstrated an additional 104 sites of infarction (of a total 172) than CT. Of these, 89 were acute and visualized only on diffusion-weighted image. MRI showed five more patients with unilateral and two more with bilateral basal ganglia infarcts than CT as well as 19 brainstem infarcts. Hydrocephalus was equally detected by MRI and CT.


MRI is superior to CT for diagnosing TBM (by detecting basal enhancement in more patients) and prognosis (by detecting many more infarcts in strategic locations). The role of CT is defined for the acute setting in detecting hydrocephalus for surgical management.


Meningitis Tuberculosis Basal enhancement Infarction DWI Hydrocephalus 


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Manana Pienaar
    • 1
  • Savvas Andronikou
    • 2
  • Ronald van Toorn
    • 3
  1. 1.Department of Radiology, Tygerberg HospitalUniversity of StellenboschStellenboschSouth Africa
  2. 2.Department of RadiologyUniversity of Cape TownCape TownSouth Africa
  3. 3.Department of Paediatrics and Child Health, Tygerberg HospitalUniversity of StellenboschStellenboschSouth Africa

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