Imaging is essential in showing complications in addition to diagnosis of CNS TB. Kornienko VN, Pronin IN. Differential diagnosis of CNS TB includes multiple brain metastases (which associated with more edema); sarcoidosis (which are associated with parenchymal nodules and have multiple dural and/or leptomeningeal nodules, multifocal or multicentric primary tumour,and fungal infections. Cns tuberculoma 1. The lesions are hyperdense on noncontrast CT scans, isointense to brain on T1W MR imaging, and isointense to hypointense on T2W images with homogeneous postcontrast enhancement. Early, accurate diagnosis can help in preventing morbidity and mortality. Services. Eventually, mass-like regions of caseous necrosis can form within this exudate, representing extra-axial tuberculomas. Mild shortening of T1 and T2 relaxation times of CSF occurs as the disease progresses. They typically appear as ring-enhancing lesions with surrounding vasogenic edema. 9. The diagnosis is made by CSF sampling, but imaging findings may be suggestive. With the onset of the human immunodeficiency virus pandemic, the incidence of tuberculosis, including central nervous system (CNS) tuberculosis, has increased in developed countries. Tuberculosis remains a leading cause of morbidity and mortality in the developing world. 3. AJNR Am J Neuroradiol. The exudate in the basal cisterns can cause obstruction to cerebrospinal fluid (CSF) flow, causing hydrocephalus, and can compress cranial nerves. A caseating granuloma is isointense to hypointense on both T1W and T2W images and shows isointense to hyperintense rim on T2W images. Ischemic infarcts are also a common complication, being seen in 20%40% of patients at CT (,Fig 10,), mostly within the b… Patients usually present with headache, seizures, focal neurologic deficit, and features of raised intracranial tension. The newer imaging techniques further help to improve the characterization and diagnosis of atypical CNS TB. Garg RK. Below is a brief discussion of the main imaging features of each presentation. Acta Radiol. Fat-saturated postcontrast T1-weighted (T1W) images (, Border zone encephalitis: postcontrast T1W image (, Hydrocephalus. Imaging of extrapulmonary tuberculosis. 12 ). Complex hydrocephalus can be seen in TB with a combination of noncommunicating (obstructive) and communicating (defective absorption) hydrocephalus ( Fig. MR imaging, with its newer sequences, helps in differentiating the type of hydrocephalus and provides most details of brain and CSF pathways. CNS involvement is thought to occur in 2-5% of patients with tuberculosis and up to 15% of those with AIDS-related tuberculosis 6,7. Tuberculosis (TB) remains a prominent global problem especially because of the increasing incidence of human immunodeficiency virus (HIV) and drug-resistant strains, although its incidence seems to have declined recently. Middle cerebral and lenticulostriate arteries are the most common vessels involved. Differential diagnosis of CNS TB includes multiple brain metastases (which associated with more edema); sarcoidosis (which are associated with parenchymal nodules and have multiple dural and/or leptomeningeal nodules, multifocal or multicentric primary tumour,and fungal infections. 1996;37 (4): 496-505. Radiograph/CT pneumoencephalography or contrast-enhanced cisternography done via lumbar puncture may help in differentiating communicating and noncommunicating hydrocephalus. It results from the haematogenous dissemination of Myco-bacterium tuberculosis from primary pulmonary infection and the formation of small subpial and subependymal foci (Rich foci) in the brain and spinal cord.1 In some individuals MR ventriculography has been used to evaluate CSF flow dynamics and in patients with hydrocephalus. Tuberculomas arise when tubercles in the parenchyma of brain enlarge without rupturing into the subarachnoid space. 2. In a known case of TB meningitis, contrast-enhanced CT scan (, Trapped ventricle: in a known case of TB meningitis with tuberculomas, MR scan reveals focal abnormal enhancement (, Complex hydrocephalus. This triad is specific for the diagnosis of TBM. Burrill J, Williams CJ, Bain G et-al. The conventional angiographic features of TBM include a triad of a hydrocephalic pattern, narrowing of arteries at the base of the brain, and narrowed or occluded small or medium-sized arteries with early draining veins. Brismar J, Hugosson C, Larsson SG et-al. It can manifest in a variety of forms as tuberculous meningitis, tuberculoma, and tubercular abscess. Other species of mycobacteria may be involved in immunocompromised patients. In the early stages, noncontrast MR imaging shows little or no evidence of meningitis. 11. The proximal portion of the nerve near its root entry is most commonly affected. British Journal of Nutrition; 106(2): 203-207; 2011. In endemic regions, tuberculomas account for as many as 50% of all intracranial masses 8. (2001) ISBN:0306465515. Abstract Central nervous system (CNS) tuberculosis is a potentially life threatening condition which is curable if the correct diagnosis is made in the early stages. It has been shown that sensitivity has been improved when more than 1 criterion was present. Tuberculosis (TB), caused by Mycobacterium tuberculosis, accounts for eight million annual, worldwide deaths. In a follow-up case of TB meningitis, T2W axial images show disproportionate enlargement of the left lateral ventricle (, TB vasculitis with acute infarct. Check for errors and try again. Thus, common imaging triad includes abnormal meningeal enhancement predominantly in the basal regions of brain and its associated complications of hydrocephalus and infarcts. tuberculous otomastoiditis). • Approximately 10% of all patients with Tuberculosis have CNS involvement. METHODS: A total of 107 tuberculomas in seven patients with or without meningitis and 15 patients with tuberculosis … The complex relationship between solid caseation, fibrosis/gliosis, macrophages, and perilesional cellular infiltrate dictates the degree of central hypointensity on T2W images. A large central Langhans giant cell (, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Neuroimaging of Viral Infections in Infants and Young Children, Epidemiology of Central Nervous System Infection, Neuropathology of Viral Infections of the Central Nervous System, Inflammation High-Field Magnetic Resonance Imaging, State-of-the-Art Pathology: New WHO Classification, Implications, and New Developments, Neuroimaging Clinics of North America Volume 22 Issue 3. MR imaging detects a greater number of infarcts and hemorrhagic transformation of infarcts than CT. … Przybojewski and colleagues evaluated these 9 criteria and showed high specificity for all the criteria, and 100% specificity for 4 individual criteria. The brain parenchyma immediately adjacent to the inflammatory exudate shows edema, perivascular infiltration, and a microglial reaction, known as border zone reaction ( Fig. Multiple large, pale histiocytes with plump cytoplasm are seen in the center. Presentation material is for education purposes only. Although CNS involvement by tuberculosis is seen in all age groups, there is a predilection for younger patients, with 60-70% of cases occurring in patients younger than 20 years of age 7. Central nervous system (CNS) tuberculosis is frequently encountered in tropical countries. 35. Postgrad Med J. Nair and colleagues described the MR imaging pattern of infarcts in TB. Also, the MT ratio (MTR) is significantly different from brain parenchyma and inflamed meninges, because the inflammatory exudate in TBM is composed of cellular infiltrate, degenerated and partially caseated fibrin, tubercles, and, less commonly, bacilli. It affects basal cisterns, sylvian fissures, and, rarely, leptomeninges over cerebral convexities. `Acute ,,p q chronic phase & its sequelae . BACKGROUND AND PURPOSE: CNS tuberculosis may simulate other granulomas and meningitis on MR images. Focal or diffuse cerebral atrophy and areas of encephalomalacia secondary to infarcts and hydrocephalus ( Fig. It subsequently develops a central area of caseating necrosis. 1. Centrally they tend to have only intermediate or even low signal on T2 weighted images (helpful in distinguishing them from the less common tuberculous abscess) 9. Clinical and paraclinical manifestations of CNS TB may simulate other neurological diseases such as tumors … In addition, the type of hydrocephalus predicts the outcome of endoscopic third ventriculostomy. CT cannot predict the level of CSF block in TBM because both types of hydrocephalus can present with panventricular dilatation. Diffusion-weighted MR imaging helps in early detection of infarction and in delineating the extent of infarction, which is of value in the management and prognostication of patients. Imaging, particularly magnetic resonance imaging, is a cornerstone in the diagnosis as well as follow-up of central nervous system (CNS) tuberculosis. Neuroradiology. A 37-year-old woman presented with headaches. According to McGuinness, 74 the target sign, defined as a central nidus of calcification or central enhancement surrounded by a ring of enhancement, is a pathognomonic finding of central nervous system TB; however, recent studies have suggested that only the target sign with central calcifications is pathognomonic of tuberculoma, whereas the target sign with a central enhancing dot does not … `Considered disease of childhood however in India all age Considered disease of childhood , however in India all age groups susceptible . Tuberculosis. It is no longer a disease confined to underdeveloped and developing countries. T2W images (, TBM with cranial nerve involvement. 7. Mycobacterium Tuberculosis Pulmonary tuberculosis Extra-pulmonary tuberculosis TB Lymphadenitis Pleural TB Skeletal TB (Bones & Joints) CNS TB – 1% of all Tuberculosis Abdominal TB Genitourinary TB Pericardial TB 3. Magnetic resonance (MR) imaging has been shown to be superior to CT in evaluating patients with suspected meningitis and its associated complications. In contrast, TB pachymeningitis is rare and is characterized by thick plaque-like regions of pachymeningeal enhancement. It may account for ≈1/6 th of the 3 million of global mortality due to Mycobacterium tuberculosis infection. Tuberculomas can occur at any age. 1. According to the World Health Organization report, 1.3 million deaths were caused by TB in 2008, which is equivalent to 20 deaths per 10,000 population. Figure 1: gross pathology: tuberculous leptomeningitis, Case 5: calcified intracranial tuberculoma, Case 17: tuberculomas associated with ischemia, herpes simplex virus 1 (HSV-1) encephalitis, herpes simplex virus 2 (HSV-2) encephalitis, varicella zoster virus (VZV) encephalitis, HIV-associated neurocognitive disorders (HANDs), progressive multifocal leukoencephalopathy, Brownell-Oppenheimer variant of sporadic Creutzfeldt-Jakob disease, Heidenhain variant of sporadic Creutzfeldt-Jakob disease, acute necrotizing encephalopathy of childhood. It also helps in differentiating tuberculous meningitis from other causes of meningitis. Yadav and colleagues reported a high incidence of complex hydrocephalus in patients with TBM and found it to be a cause of failure of endoscopic third ventriculostomy. Modern neuroimaging is the cornerstone in the early diagnosis of central nervous system (CNS) tuberculosis and may prevent unnecessary morbidity and mortality due to … MR spectroscopy-aided differentiation: "giant" extra-axial tuberculoma masquerading as meningioma. MR imaging and angiography in tuberculous meningitis. It is believed that the bacilli reach the CNS by the haematogenous route secondary to disease elsewhere in the body. (, TB pachymeningitis. Tuberculosis (TB) of the central nervous system (CNS) is a granulomatous infection caused by Mycobacterium tuberculosis.The disease predominantly involves the brain and meninges, but occasionally, it affects the spinal cord. With the onset of the human immunodeficiency virus pandemic, the incidence of tuberculosis, including central nervous system (CNS) tuberculosis, has increased in developed countries. CNS involvement usually results from hematogenous spread. It may account for ≈1/6th of the 3 million of global mortality due to Mycobacterium tuberculosis infection. [] Clinical diagnosis can be difficult; therefore, imaging has an important role in establishing the diagnosis (see the images below). 10. Its clinical and radiologic manifestations may mimic other infectious and noninfectious neurological conditions. Gupta RK, Gupta S, Singh D et-al. Tuberculous meningitis is caused by hematogenous spread from lung infection usually with caseous necrosis, granuloma formation and endarteritis; parenchymal granulomas may coalesce and rupture into the basal cisterns. Central nervous system (CNS) tuberculosis is a potentially life threatening condition which is curable if the correct diagnosis is made in the early stages. Based on the observations of Rich and McCordock, a 2-step model has been proposed for the pathogenesis of CNS TB. AJNR Am J Neuroradiol 1999;20:867-75. At first, the vessel wall is involved, and later the lumen of the vessel, leading to complete occlusion by reactive subendothelial cellular proliferation and thrombus formation. CNS infection caused by Mycobacterium tuberculosis (TB) generally has a clinical presentation and imaging appearance different from that caused by typical bacteria. Radiographics. Imaging appearance of CNS TB is becoming more and more complex and atypical with the onset of multidrug-resistant tuberculosis. Tuberculosis of the central nervous system. The term en plaque tuberculoma has been used to describe the focal pachymeningeal lesion ( Fig. Miliary CNS tuberculosis, usually associated with tuberculous meningitis, pathogenetic relationship is suspected. 8. Classic features of basal exudates, hydrocephalus, infarcts, and granulomas may not be seen in the elderly population, which has been attributed to age-related senescence of the immune system. On MT imaging, abnormal meninges appearing hyperintense on precontrast T1-weighted (T1W) MT images is considered to strongly suggest tuberculous meningitis. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Granulomas may coalesce to form tuberculomas or, rarely, an abscess. Central nervous system (CNS) tuberculosis (TB) is a dreadful form of TB which may be potentially lethal in the setting of delayed diagnosis. Unable to process the form. sciCORE. Tuberculosis of the joints is characteristically monoarticular; the knee and hip are most frequently affected. When the solid center liquefies, the center of the granuloma becomes hypodense on CT and hyperintense on T2W images with a peripheral hypointense rim and shows peripheral enhancement. The disease predominantly involves the … Life Sciences Training Facility. Presence of hyperdensity on precontrast scans in the basal cisterns might be the specific sign of TBM in children. (2009) ISBN:3540756523. Treatment of CNS tuberculosis is based on an anti-tubercular treatment regimen. 3 ). 27 (5): 1255-73. Infect. Imaging helps in early diagnosis and helps in preventing morbidity and mortality. Its clinical and radiologic manifestations may mimic other infectious and noninfectious neurological conditions. It occurs because of obstruction to CSF flow in the basal cisterns by inflammatory exudate ( Fig. Lab Ware & Media Preparation. 8 ), meningeal or ependymal calcifications, and occasionally syringomyelia or syringobulbia, are the sequelae of TBM. Presence of tuberculomas at the corticomedullary junction suggests the hematogenous spread of infection, because there is narrowing of the arterioles at the gray/white matter junction. Dr. Mac For Radiology 2. Tuberculosis: a radiologic review. Tuberculous meningitis. The authors review the imaging characteristics of different forms of CNS tuberculosis involving the brain and spine and discuss the role of advanced imaging modalities in differentiating CNS TB from other disease process. Imaging of tuberculosis. Intracranial tuberculoma: MR imaging. Not surprisingly CSF flow is disrupted, and obstructive hydrocephalus is common. 1994;36 (2): 87-92. In children, they predominate in the infratentorial compartment, whereas, in adults, the supratentorial compartment is more commonly affected. Imaging cns tb 1. For a general discussion on systemic tuberculosis, please refer to the article on tuberculosis. With greater prevalence immunocompromised patients, CNS involvement is seen in up to 15% of cases of acquired immunodeficiency syndrome – related tuberculosis. For further discussion please refer to separate articles on tuberculous leptomeningitis and tuberculous pachymeningitis. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Imaging, particularly magnetic resonance imaging, is a cornerstone in the diagnosis as well as follow-up of central nervous system (CNS) tuberculosis. Although diagnostic evaluation includes various microbiological, pathologic, molecular, and biochemical investigations, imaging modalities have an important diagnostic role. They reported that basal enhancement, tuberculomas, or both were 100% specific and 89% sensitive for the diagnosis of TBM. Specific magnetic resonance techniques, such as magnetization transfer imaging, proton magnetic resonance spectroscopy, diffusion, and perfusion imaging are useful in its characterization and management. A 43-year-old woman presenting with altered mental status and features of multiple cranial nerve involvement (in particular left fifth and seventh). The diagnosis is made by CSF sampling, but imaging findings may be suggestive. Radiographics. However, it may result from direct rupture or extension of a subependymal or subpial focus (Rich focus) and may be located in the meninges, brain, or spinal cord. Minimal or absent meningeal enhancement has been reported in patients with acquired immune deficiency syndrome (AIDS) by some investigators, likely caused by the lack of immunologic response. However, because these techniques are invasive and may be associated with complications, they should be used only if MR imaging is not available. METHODS: A total of 107 tuberculomas in seven patients with or without meningitis and 15 patients with tuberculosis ⦠Intracranial manifestations of tuberculosis are protean and can affect all compartments and are discussed individually in separate articles. The imaging appearance has become more complex with the onset of multidrug-resistant tuberculosis. Tentorial and cerebellar meningeal involvement is less common. Tuberculosis is predominantly caused by the organism mycobacterium tuberculosis and encompasses an enormously wide disease spectrum affecting multiple organs and body systems. Store & Supply. CNS involvement is thought to occur in 2-5% of patients with tuberculosis and up to 15% of those with AIDS-related tuberculosis 6,7. 6. Hence, familiarity with the imaging presentations of various forms of CNS tuberculosis is essential in timely diagnosis, and thereby reducing the morbidity and mortality of this disease. Periventricular hypodensity on CT and periventricular hyperintense signal on proton density and T2-weighted (T2W) images on MR imaging indicate interstitial edema caused by periventricular ooze of CSF secondary to increase in intraventricular pressure. Engin G, Acunaş B, Acunaş G et-al. Tuberculosis (TB) is a global clinical concern, particularly after the human immunodeficiency virus pandemic. Tuberculous meningitis. The affected nerve shows thickening and enhancement on postcontrast images. Tubercular hydrocephalus is usually communicating, accounting for 80% of cases. It is important to diagnose pachymeningeal TB because it responds well to antitubercular treatment and thus should be considered in the differential diagnosis of pachymeningeal abnormalities. The imaging appearance has become more complex with the onset of multidrug-resistant tuberculosis. Leonard JM, Des prez RM. Dis. • Greater prevalence in immunocompromised patients and is seen in ~ 15-20 % of cases of AIDS-related TB. The probability of the organism reaching the brain depends on the extent of bacteremia and the immune response of the host. However, similar imaging findings can be seen in various causes of inflammatory and noninflammatory conditions, especially meningioma. The central area of necrosis is initially solid and later may liquefy ( Fig. Noncommunicating or obstructive hydrocephalus can occur either because of obstruction of fourth ventricular outlet foramina by the basal exudates or mass effect by a focal parenchymal tuberculoma, because of brain abscess, or because of entrapment of part of a ventricle by ependymitis ( Fig. Tuberculomas show typical granulomatous reaction consisting of epithelioid cells, giant cells mixed with mononuclear inflammatory cells (predominantly lymphocytes) forming a noncaseating granuloma. Conley TB, Apolzan JA, Leidy HJ, Greaves KA, Lim E, and Campbell WW. North Am. Magnetic transfer (MT) MR imaging is an important technique and is considered superior to conventional MR imaging for showing abnormal meninges. 1999;75 (881): 133-40. others or those with possible infectious etiologies, hemorrhagic shock and encephalopathy syndrome , Intracranial manifestations of tuberculosis, Tuberculosis of the central nervous system. AJNR Am J Neuroradiol 1999;20: 867 ... – Central nervous system tuberculosis has different appearences, mostly hydrocephalus and tuberculomas. Most infarcts involve thalamus, basal ganglia, and internal capsule regions. Cell-mediated immunity is responsible for the formation of dense, gelatinous, inflammatory exudate along the basal surface of the cerebrum. 2006;27 (7): 1438-40. Parenchymal TB can occur in the form of tuberculoma, brain abscess, tuberculous encephalopathy, and tuberculous cerebritis. There can be contiguous spread of infection from the adjacent bone. 10 ). CT or MR angiogram reveal small segmental narrowing, uniform narrowing of large segments, irregular beaded appearance of vessels, or complete occlusion ( Fig. They usually occur in the absence of TBM, but may occur with meningitis because of the extension of CSF infection into the adjacent parenchyma via cortical veins or Virchow-Robin spaces. Timely diagnosis of central nervous system TB is paramount for the early institution of appropriate therapy, because delayed treatment is associated with severe morbidity and mortality. Spinal infection may result in spondylitis, arachnoiditis, … Central nervous system tuberculosis (CNS-TB) takes three clinical forms: meningitis (TBM), intracranial tuberculoma, and spinal arachnoiditis. Its clinical and radiologic manifestations may mimic other infectious and noninfectious neurological conditions. Imaging findings depend on the stage of tuberculoma, whether it is noncaseating or caseating with solid or liquid center. Infratentorial tuberculomas may present with brainstem syndromes, cerebellar symptoms, and multiple cranial nerve palsies. Gupta RK, Kathuria MK, Pradhan S. Magnetization transfer MR imaging in CNS tuberculosis. They show homogeneous enhancement on post contrast scans ( Fig. Postcontrast T1W axial images (, Sequel of TB meningitis in 4 different patients. 5. Springer Us. TBM predominates in the western world and presents as a subacute to chronic meningitis syndrome with a prodrome of malaise, fever, and headache progressing to altered mentation and focal neurologic signs, followed by stupor, coma, and death … Its clinical and radiologic manifestations may mimic other infectious and noninfectious neurological conditions. Later, this may rupture into the subarachnoid space or ventricular system leading to meningitis. Presentation material is for education purposes only. Research IT. Central nervous system (CNS) TB, the most dangerous form of extrapulmonary TB, can present as meningitis, intracranial tuberculomas, and abscesses. Communications. 20 (2): 471-88. They may be associated with extensive adjacent leptomeningeal and/or pachymeningeal enhancement. Mycobacterium TB is the most common organism causing tuberculous infection of CNS. Central nervous system (CNS) tuberculosis occurs in approximately 1% of all patients with active tuberculosis. The disadvantage of MR imaging is that the flow around the fourth ventricle may not easily be evaluated. Central nervous system (CNS) tuberculosis (TB) is a dreadful form of TB which may be potentially lethal in the setting of delayed diagnosis. MR imaging also plays an important role in the postoperative evaluation of patients with endoscopic third ventriculostomy. Neuroradiology. Ileocecal involvement is seen in 80%â90% of patients with abdominal tuberculosis. Anterior distribution, particularly in the caudate nucleus and in the presence of multiple infarcts, favored a tuberculous cause, and posterior distribution indicated the possibility of associated risk factors of stroke. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Although mycobacterium tuberculosis can involve any organ, most commonly the lung, central nervous system (CNS) tuberculosis is the most devastating form of the disease. The basal exudates cause inflammatory changes in the vessels predominantly involving the circle of Willis. A 32-year-old patient presented with severe headaches and left-sided hemiparesis. Central nervous system tuberculosis takes various forms, including meningitis, tuberculoma, abscess, cerebritis, and miliary tuberculosis. Cerebral infarction can occur because of obliterative vasculitis, the vessels at the base of the brain being severely affected. Central nervous system (CNS) tuberculosis is a potentially life threatening condition which is curable if the correct diagnosis is made in the early stages. Involvement of the central nervous system (CNS) is one of the most serious forms of this infection .Granulomatous inflammatory reaction in CNS caused by M. tuberculosis may involve the meninges, brain, spinal cord, and the bones Tuberculomas are among the most common intracranial mass lesions and the most common manifestation of parenchymal TB. Granulomatous inflammatory reaction in the CNS, caused by Mycobacterium tuberculosis, may involve the meninges, brain, spinal cord, calvarium, or bony spine. The purpose of this study was to improve the characterization of lesions in CNS tuberculosis and to assess the disease load using magnetization transfer (MT) imaging. altered sensorium, hemiparesis). Events & Courses. Gadolinium-enhanced MR angiogram is more sensitive to detect the involvement of smaller vessels. Among all other forms of TB, central nervous system (CNS) TB accounts for approximately 1% and has the highest mortality. Khanna PC, Godinho S, Patkar DP et-al. On CT, solid noncaseating granuloma is isodense or slightly hypodense to the surrounding brain parenchyma. Although CNS involvement by tuberculosis is seen in all age groups, there is a predilection for younger patients, with 60-70% of cases occurring in patients … III. Severe cases may show leptomeningeal involvement over the cerebral convexities, and extension into the ventricular system can cause ependymitis and choroid plexitis. Gupta RK, Lufkin RB. Effect of food form on postprandial plasma amino acid concentrations in older adults. CNS tuberculosis usually results from hematogenous spread. IT-Services. Modern imaging is a cornerstone in the early diagnosis of CNS tuberculosis and may prevent unnecessary morbidity and mortality. Nerve involvement occurs because of ischemia of the nerve or entrapment of the nerve in basal exudates. 11 ). ⢠Greater prevalence in immunocompromised patients and is seen in ~ 15-20 % of cases of AIDS-related TB. 5 ). The purpose of this study was to improve the characterization of lesions in CNS tuberculosis and to assess the disease load using magnetization transfer (MT) imaging. Hence, familiarity with the im ⦠Qualitative and quantitative information of CSF flow and dynamics can be obtained by MR imaging. AJNR Am J Neuroradiol. It shows rim enhancement on postcontrast images ( Fig. pulmonary tuberculosis) or direct extension from local infection (e.g. imaging in CNS tuberculosis. Imaging plays an important role in its recognition and in its differentiation from other similar conditions. Salgado P, Del brutto OH, Talamás O et-al. If there is evidence of TB elsewhere in the body, it may further suggest the diagnosis.