Abstract:

Objective: To investigate the value of three-dimensional brain volume imaging (3D BRAVO) contrast-enhanced magnetic resonance imaging (MRI) in the imaging diagnosis of intracranial tuberculosis. Methods: A total of 122 patients with intracranial tuberculosis who were clinically diagnosed and had complete data at Beijing Chest Hospital affiliated to Capital Medical University from April 2021 to August 2024 were collected as the research subjects. All patients underwent tuberculosis related laboratory tests (including cerebrospinal fluid testing), cranial MRI plain and enhanced scans, and 3D BRAVO enhanced MRI scans. The imaging characteristics of the study subjects’ skull magnetic resonance conventional enhanced scan and 3D BRAVO enhanced scan were analyzed, and the value of magnetic resonance 3D BRAVO enhanced scan in the imaging diagnosis of intracranial tuberculosis was evaluated. Results: Thirty-two cases (26.2%, 32/122) had clinical manifestations of tuberculosis poisoning and respiratory symptoms (such as cough, sputum, chest pain, etc.); 81 cases (66.4%, 81/122) experienced fever and headache; 73 cases (59.8%, 73/122) had neurological symptoms and signs, among which 113 cases (92.6%, 113/122) had routine and biochemical abnormalities in cerebrospinal fluid laboratory tests. All patients underwent lumbar puncture examination, and 57 cases (46.7%, 57/122) had intracranial pressure higher than 180 mmH₂O (1 mmH₂O=0.0098 kPa). All patients underwent routine magnetic resonance enhanced scans of their heads: 30 cases (24.6%, 30/122) showed meningeal type; 40 cases (32.8%, 40/122) showed parenchymal type, 29 cases (23.8%, 29/122) showed mixed type (meningeal and parenchymal lesions coexisted), 23 cases (18.9%, 23/122) showed no intracranial tuberculosis; Magnetic resonance 3D BRAVO enhanced scan: 43 cases (35.2%, 43/122) showed meningeal type; 22 cases (18.0%, 22/122) showed cerebral parenchyma type, 45 cases (36.9%, 45/122) showed mixed type, and 12 cases (9.8%, 12/122) showed no intracranial tuberculosis. The detection rate of lesions in intracranial tuberculosis patients by 3D BRAVO enhanced magnetic resonance imaging was significantly higher than that by conventional enhanced head magnetic resonance imaging, and the difference was statistically significant (χ²=9.091, P=0.001); The detection rate of meningeal tuberculosis was significantly higher than that of routine enhanced head magnetic resonance imaging, and the difference was statistically significant (χ²=27.034, P<0.001). Among 122 patients who underwent 3D BRAVO enhanced magnetic resonance imaging, 9 had concurrent hydrocephalus and 29 had concurrent cerebral infarction; 10 cases of concurrent cerebral neuropathy. Conclusion: Magnetic resonance 3D BRAVO enhanced scanning has important auxiliary diagnostic value for the classification and early detection of intracranial tuberculosis.

Key words: Tuberculosis, meningeal, Magnetic resonance imaging, Imaging, three-dimensional, Diagnosis, differential, Comparative study