Diagnostic accuracy of contrast-enhanced magnetic resonance imaging in diagnosing tuberculous meningitis keeping lumbar puncture as the gold standard

Abstract

Tuberculous meningitis (TM), caused by Mycobacterium tuberculosis, is the most common kind of CNS tuberculosis (TB). If not treated effectively, TB meningitis can result in a higher rate of neurologic sequelae and death.

Objective: To evaluate the diagnostic accuracy of contrast enhanced magnetic resonance imaging in diagnosing tuberculous meningitis keeping cerebrospinal fluid analysis as gold standard.

Methods: Our study comprised 109 individuals with clinical indications of tuberculous meningitis. Patients with cerebral haemorrhage, claustrophobia, or metallic implants in their bodies were not eligible. A 1.5 Tesla MRI machine was used to scan the brain starting from the vertex to the base of the skull. The MRI sequences collected and reviewed by radiologists for tuberculous meningitis were axial T2 turbo spin echo, axial T2 fluid attenuation inversion recovery (FLAIR), axial diffusion weighted imaging (DWI)—apparent diffusion coefficient (ADC), and axial T2 gradient echo (GRE). CSF analysis was performed on the patient following lumbar puncture.
Results: Out of 109 patients included in this study, 55(50.5%) were male and 54(49.5%) were females. On Contrast Enhanced FLAIR imaging patients showed abnormal features like meningeal enhancement(65.1%), tuberculomas(48.6%), hydrocephalus(47.7%) and infarts(26.6%). MRI showed a sensitivity of 76%, a specificity of 81%, a positive predictive value of 91.89% and a negative predictive value of 54.2%. Diagnostic accuracy of contrast enhanced magnetic resonance imaging in diagnosing TBM was found to be 77.1%.

Conclusion: Contrast Enhanced Magnetic Resonance Imaging has good sensitivity, specificity and diagnostic accuracy in diagnosing TB Meningitis.