Contrast medium-enhanced MRI findings and changes over time in stage I tuberculous meningitis

Aim

To demonstrate the detailed imaging characteristics of early tuberculous meningitis (TBM) and changes over time on standard gadolinium-enhanced, T1-weighted magnetic resonance imaging (MRI) images.

Materials and methods

Contrast-enhanced, T1-weighted, spin-echo MRI images of 26 patients with early TBM were evaluated retrospectively. Meningeal enhancement characteristics were categorized according to distribution and pattern as diffuse, focal, linear, nodular, and mixed.

Results

We found that 35% of patients had diffuse meningeal enhancement and 65% of cases had focal meningeal enhancement. There was a predilection for focal meningeal enhancement in basal pial areas, the interpeduncular fossa being the most common. In six patients with diffuse meningeal enhancement admitted to hospital relatively early after the onset of symptoms, the type of meningeal enhancement later changed to the focal form.

Conclusion

Reactive diffuse meningeal enhancement occurs in the early period of TBM on contrast medium-enhanced T1-weighted MR images, but later becomes limited to basal areas.