Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
J Clin Neurosci. 2013 Nov;20(11):1598-9. doi: 10.1016/j.jocn.2013.01.003. Epub 2013 May 23.
Integrity of descending white matter tracts can be evaluated by diffusion tensor imaging. In rim-enhancing intraparenchymal lesions, this technique can assist in the differentiation of demyelinating disease from tumor or abscess. Diffusion tensor imaging characteristics of tuberculoma have not been previously reported to our knowledge. A patient with headaches, dizziness, and mild left-sided weakness underwent MRI with diffusion tensor imaging. A large, rim-enhancing lesion within the pons was discovered, which subsequently was diagnosed as tuberculoma. Tractography maps prepared from diffusion tensor imaging data revealed predominantly displaced descending fiber tracts in the region of the rim-enhancing lesion. A few tracts adjacent to the lesion appeared truncated, and this abnormal finding correlated to the patient's clinical deficit. The tractography characteristics of diffusion tensor imaging in this patient potentially are distinct from those seen with demyelinating lesions, which may show more extensive tract truncation. Together with the consonance of exam findings and tract truncation seen in this patient, tractography may prove useful in the diagnosis of suspected tuberculoma.
弥散张量成像可评估下行白质束的完整性。在边缘增强的脑实质病变中，该技术可辅助鉴别脱髓鞘疾病与肿瘤或脓肿。据我们所知，结核瘤的弥散张量成像特征尚未有报道。一名头痛、头晕和轻度左侧无力的患者接受了 MRI 弥散张量成像检查。发现桥脑内有一个大的边缘增强病变，随后被诊断为结核瘤。从弥散张量成像数据制备的轨迹图显示，边缘增强病变区域主要有移位的下行纤维束。病变附近的几条轨迹看起来截断了，这种异常发现与患者的临床缺损相关。该患者弥散张量成像的轨迹特征可能与脱髓鞘病变不同，后者可能显示更广泛的轨迹截断。结合该患者检查结果和轨迹截断的一致性，轨迹成像可能有助于诊断疑似结核瘤。
