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


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


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.


CONCLUSIONS
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.
Pienaar
Manana
M
Department of Radiology, Tygerberg Hospital, University of Stellenbosch, Stellenbosch, South Africa.
Andronikou
Savvas
S
van Toorn
Ronald
R
D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D020520:Brain Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006099:Granuloma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014390:Tuberculosis, Meningeal / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*