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. 2018 Nov;91(1091):20180342.
doi: 10.1259/bjr.20180342. Epub 2018 Jul 23.

Evaluation of intracranial tuberculomas using diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS) and susceptibility weighted imaging (SWI)

Arshed Hussain Parry  1 , Abdul Haseeb Wani  1 , Feroze A Shaheen  1 , Abrar Ahad Wani  2 , Imza Feroz  3 , Mohd Ilyas  1
Affiliations

Evaluation of intracranial tuberculomas using diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS) and susceptibility weighted imaging (SWI)

Arshed Hussain Parry et al. Br J Radiol. 2018 Nov.

Abstract

Objective:: The present study was aimed to evaluate patients of suspected intracranial tuberculomas with diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS) and susceptibility-weighted imaging (SWI).

Methods:: The present study evaluated 116 patients known or suspected of having central nervous system tuberculosis with advanced MRI techniques comprising of DWI, MRS and SWI in addition to the conventional MRI.

Results:: Apparent diffusion coefficient value of tuberculomas was not significantly different (p > 0.05) from apparent diffusion coefficient value of metastatic lesions and high-grade gliomas. MRS revealed that NAA/Cr and NAA/Cho ratios of tuberculomas were not significantly different (p > 0.05) from that of malignant brain lesions. However, Cho/Cr ratio of tuberculomas (1.36 ± 0.41) was significantly lower from that of malignant brain lesions (2.63 ± 0.99). SWI revealed a complete and regular hypointense peripheral ring in 42 cases of tuberculomas (58%) and in none of the malignant brain lesions.

Conclusion:: DWI offers no clear advantage in differentiating tuberculomas from metastasis and gliomas. Tuberculomas may be differentiated from metastases and gliomas by their unique metabolite pattern on MRS. Presence of a complete and regular peripheral hypointense ring in SWI favors the diagnosis of tuberculomas.

Advances in knowledge:: The results from the present study suggest promising role of SWI in the discrimination of tuberculomas from metastatic brain lesions and gliomas with the presence of a complete and regular peripheral hypointense ring favoring the diagnosis of tuberculomas.

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Figures

Figure 1.
Figure 1.
Tuberculoma T 1W image (a) reveals a hypointense lesion in midbrain with associated hydrocephalus. The lesion is hyperintense with a peripheral hypointense rim on T 2W image (b). Post-contrast image (c) reveals ring enhancement of the lesion. DWI (d) and corresponding ADC map (e) reveals restricted diffusion in the lesion. A complete, regular peripheral hypointense ring is seen on SWI (f). MRS (g) reveals reduced levels of NAA, Cr and Cho with a lipid-lactate peak at 1.3 ppm. ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging; MRS, magnetic resonance spectroscopy; SWI, susceptibility-weighted imaging; T 1W, T 1 weighted; T 2W, T 2 weighted.
Figure 2.
Figure 2.
Metastasis T 1W image (a) reveals an isointense lesion with surrounding vasogenic edema in left posterior parietal region. T 2W image (b) shows the lesion to be slightly hypointense. On post-contrast image (c) the lesion shows thick ring of enhancement. DWI (d) and corresponding ADC map (e) shows restricted diffusion in the lesion. No peripheral hypointense ring is seen on SWI (f). MRS (g) shows marked elevation of choline peak with reduced NAA and creatine peaks. ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging; MRS, magnetic resonance spectroscopy; SWI, susceptibility-weighted imaging; T 1W, T 1 weighted; T 2W, T 2 weighted.
Figure 3.
Figure 3.
High-grade glioma T 1W image (a) showing an isointense lesion in left parietal region. The lesion is hyperintense on T 2W image (b). On post-contrast image (c) the lesion shows ring enhancement. DWI (d) and corresponding ADC map (e) reveals areas of both restricted diffusion (centre) and free diffusion (periphery) in the lesion. SWI (f) reveals an irregular and incomplete peripheral hypointense ring. MRS (g) shows markedly elevated choline levels with reduced NAA and creatine peaks. ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging; MRS, magnetic resonance spectroscopy; SWI, susceptibility-weighted imaging; T 1W, T 1 weighted; T 2W, T 2 weighted.
Figure 4.
Figure 4.
Neurocysticercosis T 1W (a) hypointense and T 2W (b) hyperintense lesion showing ring enhancement on post-contrast sequence (c) is seen in left posterior parietal region. The lesion shows free diffusion on DWI (d) and corresponding ADC map (e). On SWI (f), the lesion shows a peripheral hypointense ring. MRS (g) reveals slightly reduced NAA and Cr with Cho/Cr ratio slightly >1 with a lactate peak at 1.3 ppm. ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging; MRS, magnetic resonance spectroscopy; SWI, susceptibility-weighted imaging; T 1W, T 1 weighted; T 2W, T 2 weighted.
See this image and copyright information in PMC

Comment in

  • The susceptibility ring.
    Sanghvi D, Redij A, Munshi M, Nakshiwala V. Sanghvi D, et al. Br J Radiol. 2019 Aug;92(1100):20190034. doi: 10.1259/bjr.20190034. Epub 2019 Jul 9. Br J Radiol. 2019. PMID: 31286795 Free PMC article. No abstract available.

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