In the world of TB, Tai et al.1 assessed the sensitivity and specificity of brain MRI for diagnosing CNS tuberculosis in Malaysia. They compared imaging in patients presenting with a meningoencephalitis who had TB confirmed by cerebrospinal fluid studies (PCR or AFB) and/or by tissue examination at autopsy to the MRI findings of patients with meningoencephalitis but not TB looking for what they termed “classical” TB imaging abnormalities which included—
- Basilar enhancement
- Basal ganglia or thalamic infarcts
- Vasculitis/vasospasm evident on MRA
They found that 89% of people with TBM had ≥ 1 classical MRI finding compared to only 4% of patients with other meningoencephalitides. Their study population was largely HIV uninfected (only 7% HIV positive). There would be significant value to determining if the excellent sensitivity and specificity of imaging in this population holds true for people with HIV.
- Tai MS, Mohn Nor, H., Rahmat, K., Viswanathan, S., Abdul Kadir, A., Ramli, N., Abu Bakar, F.K., Mohd Zain, N.R., Abdullak, S., Yap, J.F., Shaheed, J., Ng, B.S., Rafia, M.H., Tan, C.T. Neuroimaging findings are sensitive and specific in diagnosis of tuberculous meningitis. Neurology Asia 2017; 22(1): 15-23.