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首页> 外文期刊>Journal of Clinical and Diagnostic Research >Tuberculoma Versus Neurocysticercosis: Can Magnetic Resonance Spectroscopy and Diffusion Weighted Imaging Solve the Diagnostic Conundrum?
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Tuberculoma Versus Neurocysticercosis: Can Magnetic Resonance Spectroscopy and Diffusion Weighted Imaging Solve the Diagnostic Conundrum?

机译：结核与神经囊虫病：磁共振波谱和弥散加权成像能否解决诊断难题？

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Tuberculoma and Neurocysticercosis (NCC) are the two most common infectious causes of intracranial ring enhancing lesions seen on CT and MRI in developing countries. They share common clinical and neuroimaging findings most of the times resulting in diagnostic conundrum. It is very important to differentiate these two conditions to avoid improper treatment. Magnetic Resonance Spectroscopy (MRS) and Diffusion Weighted Imaging (DWI) as additional imaging tools help to differentiate the two conditions when faced with diagnostic dilemma.Aim: To evaluate the utility of MRS and DWI as an adjuvant in differentiating tuberculoma and NCC.Materials and Methods: This was a retrospective study where the MRI of 30 subjects with clinical diagnosis of either tuberculoma or NCC were analysed. Imaging sequences included T1W, T2W, FLAIR, DWI, MRS images and post contrast T1W FS images. The data on MRS and DWI findings of both the conditions were collected. The correlation between the MRS and DWI findings with the lesions was studied. Finally, the data were pooled and analysed. Radiological diagnosis of the findings was confirmed by reasons to clinical trials (albendazole 15 mg/kg for one week for NCC and appropriate ATT for tuberculoma) in terms of remission of clinical symptoms and follow-up imaging for decrease in the size of the lesion and perilesionaloedema.Results: NCC cases showed no lipid peak whereas tuberculoma lesions except one showed predominant lipid peaks. Both lesions showed reduced N-acetylaspartate (NAA) levels. NCC lesions showed acetate/succinate or both peaks whereas these metabolites were normal in tuberculoma lesions. Cho/creatinine ratio was normal in all cases of NCC. Seven out of 17 tuberculoma lesions showed increased Cho/creatinine ratio (greater than 1) and almost all the lesions showed elevated normalised Cho/Cr ratio reflecting increased membrane damage and cellularity tuberculoma. All tuberculoma lesions except three showed restricted diffusion whereas none of the NCC lesions showed restricted diffusion.Conclusion: MRS and DWI are very useful imaging tools which when used along with conventional MRI imaging helps to differentiate tuberculoma from NCC and vice versa. These MR sequences when employed together will obviate the need for unnecessary biopsy thus helps in immediate clinical management and also follow-up.
机译：结核和神经囊虫病（NCC）是发展中国家在CT和MRI上发现的颅内环增强病变的两个最常见的感染原因。他们大多数时候都有共同的临床和神经影像学发现，从而导致诊断难题。区分这两种情况以避免不正确的治疗非常重要。磁共振波谱（MRS）和弥散加权成像（DWI）作为附加的成像工具，有助于在面对诊断难题时区分两种情况。目的：评估MRS和DWI在区分结核和NCC方面的辅助作用材料和方法：这是一项回顾性研究，其中分析了30例临床诊断为结核或NCC的MRI。成像序列包括T1W，T2W，FLAIR，DWI，MRS图像和对比后的T1W FS图像。收集了两种情况下有关MRS和DWI发现的数据。研究了MRS和DWI发现与病变之间的相关性。最后，对数据进行汇总和分析。通过临床试验缓解（临床症状缓解和随访影像学检查，以减少病灶大小和大小）的临床试验（阿苯达唑15 mg / kg，NCC 1周，结核病适当ATT）的原因，对结果进行了放射学诊断。结果：NCC病例未见脂质峰，而结核病灶除外，其中一例显示脂质峰为主。两种皮损均显示N-乙酰天门冬氨酸（NAA）水平降低。 NCC病变显示乙酸盐/琥珀酸盐或两个峰，而这些代谢物在结核瘤病变中是正常的。在所有NCC病例中，Cho /肌酐比值均正常。在17个结核瘤病变中，有7个显示出Cho /肌酐比值增加（大于1），几乎所有病变显示出正常的Cho / Cr比值升高，反映了膜损伤和细胞性结核的增加。 b。结论：MRS和DWI是非常有用的成像工具，当与常规MRI成像结合使用时，有助于区分结核与NCC，反之亦然，除了三个以外，所有结核瘤病变均显示出扩散受限。当这些MR序列一起使用时，将无需进行不必要的活检，因此有助于立即进行临床管理和随访。

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