Perfusion magnetic resonance imaging in differentiation of neurocysticercosis and tuberculoma.

Abstract

Tuberculoma and neurocysticercosis (NCC) are two of the most common intracranial infections in developing countries and cause of seizures or focal neurological deficit. They often present on neuroimaging as ring-enhancing lesions, and in absence of typical imaging features, can cause significant diagnostic dilemma. Differentiation is extremely important to avoid empirical exposure to anti-tubercular treatment or nonspecific treatment causing disease progression. The aim our study was to evaluate the MR perfusion characteristics of brain tuberculoma and NCC and to assess the potential role of the perfusion in differentiating the two entities. Fifty untreated patients (20 tuberculoma and 30 NCC) were prospectively evaluated by using conventional imaging and dynamic susceptibility contrast (DSC) MR perfusion. Relative cerebral blood volume (rCBV) values were calculated from the wall and core of the lesion and were compared with contralateral normal white matter. rCBV values from the wall of the lesion were significantly different in tuberculoma and NCC (P < 0.05). Tuberculomas showed high mean rCBV values than NCC (3.3 and 1.3 respectively). The core of these lesions showed lower rCBV values in both the lesions which were lower than normal white matter. A cutoff value of rCBV from the wall of the lesion 1.965 for tuberculoma showed 90% sensitivity and 100% specificity. Perfusion MRI in combination with conventional sequences can better characterize and differentiate similar-appearing tuberculoma and NCC and may be incorporated in routine protocol which may help in avoiding brain biopsy and empirical therapy.