title: Perfusion magnetic resonance imaging characteristics of intracerebral tuberculomas and its role in differentiating tuberculomas from metastases.
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.
  
  
  OBJECTIVE
  To study the MRI perfusion characteristics of tuberculomas and its potential role in their definitive diagnosis.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Radiology, Seth GS Medical College and KEM Hospital, Thane, India.
authors: Shilpa
authors: S
authors: Sankhe
authors: Akshay
authors: A
authors: Baheti
authors: Ashish
authors: A
authors: Ihare
authors: Shobhit
authors: S
authors: Mathur
authors: Poonam
authors: P
authors: Dabhade
authors: Ashish
authors: A
authors: Sarode
mesh_terms: D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016862:Tuberculoma, Intracranial / Q000175:diagnosis*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA