Skip to main content

Advertisement

SpringerLink
Log in

MR vessel wall imaging in tubercular meningitis

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

Tubercular meningitis (TBM) has the propensity to cause secondary vasculitis through various mechanisms leading to development of cerebrovascular complications. These vascular involvements can be detected by vessel wall imaging (VWI). In this study, we aimed to study detailed findings of vessel wall imaging in cases of tubercular meningitis.

Methods

All consecutive patients of suspected tubercular meningitis in whom diagnosis of TBM could be made according to diagnostic criteria given by Ahuja et al. were included in the study. High-resolution MR VWI and time of flight (TOF) magnetic resonance angiography (MRA) were done along with routine MRI sequences. Arteries up to second-order branches were studied, and statistical analyses were done with respect to stage of tubercular meningitis, infarctions and TOF MRA findings.

Results

Out of all 101 cases of TBM, infarctions were found in 49 cases (48.5%), and vessel wall enhancement was seen in 67 cases (66.3%). With increasing severity of disease, more severe vascular involvement was seen on VWI. There was significant association between enhancement of individual arteries and infarctions in their territories. VWI had better sensitivity than the MRA, while MRA had better specificity than VWI for detection of vascular complications.

Conclusion

Tubercular vasculitis can be detected by VWI in the form of nodular or smooth segmental enhancement of vessel wall with or without stenosis. Incorporation of VWI in routine MR imaging can play a greater role in early detection and management of cerebrovascular complications which can help to improve prognosis of the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

ACA:

Anterior cerebral artery

BA:

Basilar artery

CSF:

Cerebrospinal fluid

DSA:

Digital subtraction angiography

FOV:

Field of view

FS:

Fat suppressed

GCS:

Glasgow coma scale

ICA:

Internal cerebral artery

MCA:

Middle cerebral artery

MRA:

Magnetic resonance angiography

PCA:

Posterior cerebral artery

TBM:

Tubercular meningitis

TE:

Time of echo

TOF:

Time of flight

TR:

Time of repetition

VWI:

Vessel wall imaging

References

  1. Sharma DC (2019) India launches tuberculosis prevalence survey. Lancet Respir Med 7(12):1009

    Article  Google Scholar 

  2. Rock RB, Olin M, Baker CA, Molitor TW, Peterson PK (2008) Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev 21(2):243–261. https://doi.org/10.1128/CMR.00042-07

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Thwaites GE, van Toorn R, Schoeman J (2013) Tuberculous meningitis: more questions, still too few answers. Lancet Neurol 12(10):999–1010. https://doi.org/10.1016/S1474-4422(13)70168-6

    Article  CAS  PubMed  Google Scholar 

  4. Patkar D, Narang J, Yanamandala R, Lawande M, Shah GV (2012) Central nervous system tuberculosis. Neuroimaging Clin N Am 22(4):677–705. https://doi.org/10.1016/j.nic.2012.05.006

    Article  PubMed  Google Scholar 

  5. Gupta RK, Gupta S, Singh D, Sharma B, Kohli A, Gujral RB (1994) MR imaging and angiography in tuberculous meningitis. Neuroradiology 36(2):87–92. https://doi.org/10.1007/BF00588066

    Article  CAS  PubMed  Google Scholar 

  6. Siva A (2001) Vasculitis of the nervous system. J Neurol 248(6):451–468. https://doi.org/10.1007/s004150170154

    Article  CAS  PubMed  Google Scholar 

  7. Mandell DM, Mossa-Basha M, Qiao Y, Hess CP, Hui F, Matouk C, Johnson MH, Daemen MJAP, Vossough A, Edjlali M, Saloner D, Ansari SA, Wasserman BA, Mikulis DJ (2017) Intracranial vessel wall MRI: principles and expert consensus recommendations of the American Society of Neuroradiology. Am J Neuroradiol 38(2):218–229. https://doi.org/10.3174/ajnr.A4893

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Song JW, Lehman L, Rivkin M, Gorman MP, Yang E (2019) Serial vessel wall MR imaging of pediatric tuberculous vasculitis. Neurol Clin Pract 9(6):459–461. https://doi.org/10.1212/CPJ.0000000000000623

    Article  PubMed  PubMed Central  Google Scholar 

  9. Mossa-Basha M, Hwang WD, De Havenon A, Hippe D, Balu N, Becker KJ et al (2015) Multicontrast high-resolution vessel wall magnetic resonance imaging and its value in differentiating intracranial vasculopathic processes. Stroke 46(6):1567–1573. https://doi.org/10.1161/STROKEAHA.115.009037

    Article  PubMed  Google Scholar 

  10. Roh SY, Jang H, Kim DY, Kim JY (2016) Atypical manifestation of multiple cerebral infarctions in tuberculous meningitis on vessel wall imaging. Int J Neurol Brain Disord 3(1):1–3. https://doi.org/10.15436/2377-1348.15.022

    Article  Google Scholar 

  11. Lu T, Zou Y, Jiang T, Yang Y, Wu A, Chen H, Kang Z, Lin X, Fang Y, Lu Z (2020) Intracranial artery injury in HIV-negative tuberculous meningitis: a high-resolution vessel wall imaging study. Clin Neuroradiol 30(2):381–388. https://doi.org/10.1007/s00062-019-00766-4

    Article  PubMed  Google Scholar 

  12. Ahuja GK, Mohan KK, Prasad K, Behari M (1994) Diagnostic criteria for tuberculous meningitis and their validation. Tuber Lung Dis 75(2):149–152. https://doi.org/10.1016/0962-8479(94)90045-0

    Article  CAS  PubMed  Google Scholar 

  13. Baradaran H, Patel P, Gialdini G, Al-Dasuqi K, Giambrone A, Kamel H et al (2017) Quantifying intracranial internal carotid artery stenosis on MR angiography. Am J Neuroradiol 38(5):986–990. https://doi.org/10.3174/ajnr.A5113

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Nair PP, Kalita J, Kumar S, Misra UK (2009) MRI pattern of infarcts in basal ganglia region in patients with tuberculous meningitis. Neuroradiology 51(4):221–225. https://doi.org/10.1007/s00234-009-0495-x

    Article  CAS  PubMed  Google Scholar 

  15. Wasay M, Khan M, Farooq S, Khowaja ZA, Bawa ZA, Mansoor Ali S, Awan S, Beg MA (2018) Frequency and impact of cerebral infarctions in patients with tuberculous meningitis. Stroke 49(10):2288–2293. https://doi.org/10.1161/STROKEAHA.118.021301

    Article  PubMed  Google Scholar 

  16. Wang Y (2015) Immunologic cerebral vasculitis and extrapulmonary tuberculosis: an uncommon association. J Clin Diagn Res 9(9):OD03–OD05. https://doi.org/10.7860/JCDR/2015/13885.6497

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chatterjee D, Radotra B, Vasishta R, Sharma K (2015) Vascular complications of tuberculous meningitis: an autopsy study. Neurol India 63(6):926. https://doi.org/10.4103/0028-3886.170086

    Article  PubMed  Google Scholar 

  18. Kalita J, Misra UK, Nair PP (2009) Predictors of stroke and its significance in the outcome of tuberculous meningitis. J Stroke Cerebrovasc Dis 18(4):251–258. https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.11.007

    Article  PubMed  Google Scholar 

  19. Shukla R, Abbas A, Kumar P, Gupta RK, Jha S, Prasad KN (2008) Evaluation of cerebral infarction in tuberculous meningitis by diffusion weighted imaging. J Infect 57(4):298–306. https://doi.org/10.1016/j.jinf.2008.07.012

    Article  PubMed  Google Scholar 

  20. Dastur DK, Lalitha VS, Udani PM, Parekh U (1970) The brain and meninges in tuberculous meningitis-gross pathology in 100 cases and pathogenesis. Neurol India 18(2):86–100

    CAS  PubMed  Google Scholar 

  21. Bhargava S, Gupta AK, Tandon PN (1982) Tuberculous meningitis—a CT study. Br J Radiol 55(651):189–196. https://doi.org/10.1259/0007-1285-55-651-189

    Article  CAS  PubMed  Google Scholar 

  22. Lu T-T, Lin X-Q, Zhang L, Cai W, Dai Y-Q, Lu Z-Z, Wu AM, Bao J, Yang Y, Hu XQ, Lu ZQ (2015) Magnetic resonance angiography manifestations and prognostic significance in HIV-negative tuberculosis meningitis. Int J Tuberc Lung Dis 19(12):1448–1454. https://doi.org/10.5588/ijtld.15.0113

    Article  PubMed  Google Scholar 

  23. Singh B, Garg RK, Singh MK, Verma R, Malhotra HS, Jain A, Singh R, Kohli N, Phadke RV, Shukla R, Parihar A (2012) Computed tomography angiography in patients with tuberculous meningitis. J Infect 64(6):565–572. https://doi.org/10.1016/j.jinf.2012.03.015

    Article  PubMed  Google Scholar 

  24. Kalita J, Prasad S, Maurya PK, Kumar S, Misra UK (2012) MR angiography in tuberculous meningitis. Acta Radiol 53(3):324–329. https://doi.org/10.1258/ar.2012.110712

    Article  PubMed  Google Scholar 

  25. Misra UK, Kalita J, Nair PP (2010) Role of aspirin in tuberculous meningitis: a randomized open label placebo controlled trial. J Neurol Sci 293(1–2):12–17. https://doi.org/10.1016/j.jns.2010.03.025

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

Department of Biotechnology vide grant no. BT/PR23178/MED/29/1183/2017

Author information

Authors and Affiliations

  1. Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India

    Neha Choudhary, Sameer Vyas, Shashank Raj, Ajay Kumar, Chirag Kamal Ahuja & Paramjeet Singh

  2. Department of Neurology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India

    Manish Modi & Manoj Kumar Goyal

  3. Department of Pediatric Neurology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India

    Naveen Sankhyan, Renu Suthar & Arushi Gahlot Saini

Authors
  1. Neha Choudhary
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sameer Vyas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Manish Modi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shashank Raj
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ajay Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Naveen Sankhyan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Renu Suthar
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Arushi Gahlot Saini
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Manoj Kumar Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chirag Kamal Ahuja
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Paramjeet Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sameer Vyas.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Choudhary, N., Vyas, S., Modi, M. et al. MR vessel wall imaging in tubercular meningitis. Neuroradiology 63, 1627–1634 (2021). https://doi.org/10.1007/s00234-021-02678-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-021-02678-y

Keywords

Search

Navigation