Sahu Chandradev, Bhargava Nishant, Singh Vivek, Dwivedi Pranav
Department of Neuroradiology, Pt. Jawahar Lal Nehru Memorial Medical College (PT JNMC), Raipur, Chhattisgarh, India.
Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India.
J Pediatr Neurosci. 2020 Jul-Sep;15(3):204-213. doi: 10.4103/jpn.JPN_78_19. Epub 2020 Nov 6.
Tuberculosis continues to be a major infectious disease in developing parts of the world. Primarily central nervous system tuberculosis manifests as meningitis, tuberculoma, or a brain abscess; however, rarely it may manifest as a large neoplastic mass such as lesion known as giant tuberculoma. Especially in central parts of India, the incidence of giant tuberculoma is quite high in pediatric population that too in posterior fossa of brain. Often, they are wrongly reported as neoplastic masses on imaging. The objective of this study was to evaluate different imaging appearances of a giant tuberculoma.
In this prospective study, all cases of giant tuberculoma presenting to a large tertiary care center in central India for 2 years (duration 2016-2018) were imaged and followed up. A total of nine patients, six females and three males, aged 4-16 years were studied on a 3-Tesla Siemens magnetic resonance imaging (MRI) scanner.
In total, nine patients were included with 11 giant tuberculomas. Of 11, eight were infratentorial and three were supratentorial in location. On T2-weighted image sequence, these lesions showed central hypointensity with a peripheral hyperintense rim. Most observed finding on T1-weighted image sequence was central isointensity with peripheral hyperintense rim. Advanced imaging sequences such as magnetic resonance spectroscopy and magnetization transfer were also applied.
To the best of our knowledge, this is the largest series of giant tuberculoma in the pediatric population reported so far in any part of the world. We have described the various MRI imaging findings of this lesion in great details. Management of such rare cases and pertinent literature is reviewed briefly.
结核病在世界上的发展中地区仍然是一种主要的传染病。中枢神经系统结核病主要表现为脑膜炎、结核瘤或脑脓肿；然而，它很少表现为巨大的肿瘤样肿块，如巨大结核瘤。特别是在印度中部地区，巨大结核瘤在儿童人群中的发病率相当高，且多位于脑的后颅窝。在影像学检查中，它们常常被错误地报告为肿瘤样肿块。本研究的目的是评估巨大结核瘤的不同影像学表现。
在这项前瞻性研究中，对2016年至2018年期间在印度中部一家大型三级医疗中心就诊的所有巨大结核瘤病例进行了影像学检查和随访。共有9例患者，6名女性和3名男性，年龄在4至16岁之间，在一台3特斯拉的西门子磁共振成像（MRI）扫描仪上进行了研究。
总共纳入了9例患者，共11个巨大结核瘤。在这11个结核瘤中，8个位于幕下，3个位于幕上。在T2加权图像序列上，这些病变表现为中心低信号，周边高信号环。在T1加权图像序列上最常见的表现是中心等信号，周边高信号环。还应用了磁共振波谱和磁化传递等高级成像序列。
据我们所知，这是迄今为止世界上任何地区报道的最大系列儿童巨大结核瘤病例。我们详细描述了该病变的各种MRI影像学表现。简要回顾了此类罕见病例的治疗及相关文献。
