Comparative study of CNS tuberculoma and Neuro-cysticercosis with CT and MRI

ABSTRACT

Background and aims: CNS infections are usually diagnosed by clinical assessment and laboratory investigations, particularly cerebrospinal fluid (CSF) analysis, combined with radiologic findings. Radiology plays a vital role by providing the differential diagnosis and occasionally identifying a particular entity with a characteristic appearance. Imaging is also crucial for identifying disease complications and assessing response to treatment. Material and methods: Cases are referred to the Radiology department based on clinical signs and symptoms. Contrast-enhanced Computed Tomography (CT) & Magnetic Resonance Imaging (MRI) of the brain were done routinely. Written consent was taken in all cases for the contrast study. Additional sequences like Magnetic Resonance Spectroscopy (MRS), Diffusion-Weighted Imaging (DWI), and Susceptibility Weighted Imaging (SWI) characteristics of the lesions were evaluated. Results: Our study group comprised 50 cases of CNS infection. Males are more commonly affected than females. Neurocysticercosis (NCC) was the most common (60%), followed by tuberculosis. Headache (90%) and vomiting (80%) were the common presenting symptoms. Tuberculoma lesions mainly were between 1-3 cm in size. 60% of cases showed multiplicity. 78% of the NCC cases showed multiple lesions, with perilesional oedema present in 74% of the cases. Mass effect was not a predominant finding in NCC cases. The T2 intensity of lesion varied between hyperintensity and heterointensity, with most cases (75%) being T2 hyperintensity. Conclusion:  Our study found MRI superior to CT in diagnosing and characterizing tuberculoma and NCC lesions.

Keywords: CNS Infection; Neurocysticercosis; Diffusion-Weighted Imaging; Magnetic Resonance Spectroscopy.