Document Detail

Assessment of therapeutic response in brain tuberculomas using serial dynamic contrast-enhanced MRI.
MedLine Citation:
PMID:  18374721     Owner:  NLM     Status:  MEDLINE    
AIM: To assess the most useful dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) index in the evaluation of the therapeutic response in brain tuberculoma (BT) patients. SUBJECTS AND METHODS: Twenty-three patients with 25 BT lesions were serially evaluated using DCE MRI. All lesions were classified into two groups: group I (n=15) included patients who showed clinical, as well as imaging, improvement; and group II (n=10) included patients with either clinical or radiological deterioration. The group I and group II lesions were examined for up to 12 months at 4 monthly intervals. However, the lesions in five patients of group II were excised following clinical deterioration after 4 months of therapy. The perfusion indices, i.e., relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), permeability (k(trans)), and leakage (v(e)), were quantified at each time point. The cellular, necrotic, and total volumes of lesion, together with the oedema volume, were also calculated. RESULTS: All patients in group I and three in group II showed a significant decrease in all perfusion indices, together with the oedema volume, after 1 year. In these three patients in group II, increase in rCBV was associated with increased cellular volume fraction whereas the k(trans), v(e), and oedema volume decreased significantly after 4 months. In five patients in group II who underwent excision of the lesion after 4 months of therapy due to clinical deterioration, the decrease in rCBV was associated with significant increase in k(trans) and oedema volume without any significant change in lesion volume. The rCBV correlated significantly with the cellular volume, whereas k(trans) showed a significant correlation with the v(e) and oedema volume at each time point. CONCLUSION: In BT, changes in k(trans) and oedema volume are associated with a therapeutic response at 4 months, even when there is a paradoxical increase in the lesion volume.
M Haris; R K Gupta; M Husain; C Srivastava; A Singh; R K Singh Rathore; S Saksena; S Behari; N Husain; C Mohan Pandey; K Nath Prasad
Publication Detail:
Type:  Journal Article     Date:  2008-01-14
Journal Detail:
Title:  Clinical radiology     Volume:  63     ISSN:  0009-9260     ISO Abbreviation:  Clin Radiol     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-03-31     Completed Date:  2008-08-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1306016     Medline TA:  Clin Radiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  562-74     Citation Subset:  IM    
Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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MeSH Terms
Blood Volume
Brain / blood supply*
Cerebrovascular Circulation
Child, Preschool
Contrast Media
Magnetic Resonance Imaging / methods*
Treatment Outcome
Tuberculoma, Intracranial / diagnosis*,  therapy
Tuberculosis, Meningeal / diagnosis*,  therapy
Reg. No./Substance:
0/Contrast Media

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