Abstract:

Objective To investigate the MR imaging features of hematogeneous pulmonary tuberculosis accompanied with intracranial tuberculosis in adult patients, in order to reduce the misdiagnosis and missed diagnosis. Methods Clinical and imaging data of 53 patients diagnosed of hematogeneous pulmonary tuberculosis accompanied with intracranial tuberculosis in Beijing Chest Hospital affiliated to Capital Medical University from February 2015 to July 2019 were retrospectively analyzed. And of them, 48 patients with complete information were selected. They were all tested with laboratory examination related tuberculosis (including cerebrospinal fluid examination), as well as MR scan and enhanced MR examination; the results were investigated was and evaluated. Results Of the 48 cases, symptoms of tuberculosis and respiratory symptoms were found in 24 cases (50.0%), 36 (75.0%) were with fever and headache, symptoms and signs of nervous system were found in 29 (60.4%) cases; diffuse miliary shadow of lungs was found by chest CT; cerebrospinal fluid examination were abnormal in 45 cases (93.8%), and protein elevated in 43 (89.6%), glucose (38, 79.2%) and chloride (37, 77.1%) reduced; all the patients underwent lumbar puncture, and intracranial pressure increased (>180 mm H₂O (1 mm H₂O=0.0098 kPa)) in 31 (64.6%). All the 48 patients were examined by cranial enhanced MRI. In 8 cases (16.7%), no tuberculosis lesion was found; brain parenchyma and/or meningeal tuberculosis were fond in 40 patients, including simple meningeal tuberculosis (n=9, 18.8%), simple parenchymal tuberculosis (n=19, 39.6%) and mixed intracranial tuberculosis (n=12, 25.0%). However, by MR, cranial lesions were found just in 35 patients; of the other 13 patients, 8 were found by enhanced MRI, and still no lesion was found in 5 cases. Of the 25 patients re-examined by MRI after 3-month anti-tuberculosis treatment, 11 improved, 7 worsened, 5 partially improved, and 2 without any change. Conclusion Fever, headache, symptoms and signs of nervous system, abnormal cerebrospinal fluid and biochemical examination, and increased intracranial pressure are often found in patients of hematogeneous pulmonary tuberculosis accompanied with intracranial tuberculosis, and MR scan could find most of the abnormalities. Enhanced MR could supply even more information. MR scan is an important examination for the diagnosis of intracranial tuberculosis.

Key words: Tuberculosis,pulmonary, Tuberculosis,miliary, Tuberculosis,central nervous system, Disease attributes, Magnetic resonance imaging, Evaluation studies