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

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Abstract

Background

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.

Aim

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Department of Radiology, Tygerberg Hospital, University of Stellenbosch, Stellenbosch, South Africa

    Manana Pienaar

  2. Department of Radiology, University of Cape Town, Cape Town, South Africa

    Savvas Andronikou

  3. Department of Paediatrics and Child Health, Tygerberg Hospital, University of Stellenbosch, Stellenbosch, South Africa

    Ronald van Toorn

Authors
  1. Manana Pienaar
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  2. Savvas Andronikou
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  3. Ronald van Toorn
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Corresponding author

Correspondence to Savvas Andronikou.

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Pienaar, M., Andronikou, S. & van Toorn, R. MRI to demonstrate diagnostic features and complications of TBM not seen with CT. Childs Nerv Syst 25, 941–947 (2009). https://doi.org/10.1007/s00381-008-0785-3

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  • DOI: https://doi.org/10.1007/s00381-008-0785-3

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