Differentiating Between Solitary Ring Enhancing Neurocysticerosisand Tuberculoma: Prospective Cross Sectional Study in Adult Population
Solitary ring enhancing Neurocysticerosis and Tuberculoma
Background: Tuberculoma and neurocysticercosis of the brain remains a diagnostic challenge. MR Spectroscopy is a potential tool for differentiating between infectious and non-infectious lesions. This study was undertaken to assess differentiating characteristics on MRI and MR Spectroscopy of solitary tuberculoma and neurocysticercosis. Subjects and Methods: This was a prospective cross sectional study conducted in the Department of Radiodiagnosis of JNMCH, Aligarh over a period of 3 years performed on 1.5T Siemens MR Scanner. 100 patients with brain imaging finding of a solitary ring enhancing lesion (SREL) were consecutively included in the study and further worked up and the patients with the final diagnosis of tuberculosis or neurocysticercosis were evaluated with MR Spectroscopy. Results: Out of 100 patients, 86 were positive for nerocysticercosis or tuberculoma. The maximum numbers of cases were seen in the second and third decade of life. The overall male to female ratio in our study was~ 2:1. MR Spectroscopy in tuberculomas showed a lipid peak in 81% cases which was not seen in neurocysticercosis. MR Spectroscopy showed statistically significant difference in the ratios of CHO/CR and CHO/NAA in tuberculoma and neurocysticercosis. The ratio of CHO/CR, CHO/NAA, and NAA/CR was less than 1.5 in 83%, 88%, and 95% cases of neurocysticercosis, respectively. Conclusion: MRI + MR Spectroscopy can help to differentiate between them and MR Spectroscopy should be a part of routine brain MRI for cases with SREL.