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Assessment of Blood–Brain Barrier Integrity in Tuberculous Meningitis Using Dynamic Contrast-Enhanced MR Perfusion
Objective Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis. The aim of the study was to quantitatively evaluate blood–brain barrier (BBB) perfusion changes in TBM patients using dynamic contrast-enhanced (DCE) MR perfusion.
Methods and Material Thirty untreated patients of TBM and 10 healthy controls were prospectively evaluated by conventional imaging and DCE MR perfusion. Mean permeability indices—Ktrans and Ve—were calculated from multiple regions of interest (ROIs) placed in basal cisterns and comparison was done between the patients and controls.
Results The permeability indices were significantly higher (where p < 0.001) in cisterns of TBM patients who showed basal meningeal enhancement when compared with healthy controls. Significant differences in permeability were observed between “enhancing” cases and controls as well as in “enhancing” cases when compared with the “non-enhancing” cases. However, no significant difference was observed in the mean cisternal value between “non-enhancing” cases and the controls. Ktrans with a cutoff value of > 0.0838 had 81.6% sensitivity and 78.6% specificity in differentiating cases and controls while Ve mean value with a cutoff value of 0.0703 showed 86.8% sensitivity and 91.4% specificity in predicting the permeability difference between the cases and controls.
Conclusion DCE MR perfusion is useful in the quantitative measurement of disruption of BBB and perfusion alterations in patients of TBM.
01 June 2021 (online)
© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 1 Shirani K, Talaei Z, Yaran M, Ataei B, Mehrabi-Koushki A, Khorvash F. Diagnosed tuberculous meningitis using cerebrospinal fluid polymerase chain reaction in patients hospitalized with the diagnosis of meningitis in referral hospitals in Isfahan. J Res Med Sci 2015; 20 (03) 224-227
- 2 Kashyap RS, Agarwal NP, Chandak NH. et al. The application of the Mancini technique as a diagnostic test in the CSF of tuberculous meningitis patients. Med Sci Monit 2002; 8 (06) MT95-MT98
- 3 Garg RK, Malhotra HS, Jain A. Neuroimaging in tuberculous meningitis. Neurol India 2016; 64 (02) 219-227
- 4 Schoeman JF, Donald PR. Tuberculous meningitis. Handb Clin Neurol 2013; 112: 1135-1138
- 5 Abbott NJ, Friedman A. Overview and introduction: the blood-brain barrier in health and disease. Epilepsia 2012; 53 (Suppl. 06) 1-6
- 6 Sharma S, Goyal MK, Sharma K. et al. Cytokines do play a role in pathogenesis of tuberculous meningitis: a prospective study from a tertiary care center in India. J Neurol Sci 2017; 379: 131-136
- 7 Domingo-Gonzalez R, Prince O, Cooper A, Khader SA. Cytokines and chemokines in mycobacterium tuberculosis infection. Microbiol Spectr 2016; 4 (05) 10
- 8 Abdelmalek R, Kanoun F, Kilani B. et al. Tuberculous meningitis in adults: MRI contribution to the diagnosis in 29 patients. Int J Infect Dis 2006; 10 (05) 372-377
- 9 Sanei Taheri M, Karimi MA, Haghighatkhah H, Pourghorban R, Samadian M, Delavar Kasmaei H. Central nervous system tuberculosis: an imaging-focused review of a reemerging disease. Radiol Res Pract 2015; 2015: 202806
- 10 Haris M, Husain N, Singh A. et al. Dynamic contrast-enhanced (DCE) derived transfer coefficient (Ktrans) is a surrogate marker of matrix metalloproteinase 9 (MMP-9) expression in brain tuberculomas. J Magn Reson Imaging 2008; 28 (03) 588-597
- 11 Brandt CT, Simonsen H, Liptrot M. et al. In vivo study of experimental pneumococcal meningitis using magnetic resonance imaging. BMC Med Imaging 2008; 8: 1
- 12 Heye AK, Culling RD, Valdés Hernández MdelC, Thrippleton MJ, Wardlaw JM. Assessment of blood-brain barrier disruption using dynamic contrast-enhanced MRI. A systematic review. Neuroimage Clin 2014; 6: 262-274
- 13 Ahuja GK, Mohan KK, Prasad K, Behari M. Diagnostic criteria for tuberculous meningitis and their validation. Tuber Lung Dis 1994; 75 (02) 149-152
- 14 Tofts PS, Kermode AG. Measurement of the blood-brain barrier permeability and leakage space using dynamic MR imaging. 1. Fundamental concepts. Magn Reson Med 1991; 17 (02) 357-367
- 15 Kassner A, Roberts T, Taylor K, Silver F, Mikulis D. Prediction of hemorrhage in acute ischemic stroke using permeability MR imaging. AJNR Am J Neuroradiol 2005; 26 (09) 2213-2217
- 16 Varatharaj A, Liljeroth M, Darekar A, Larsson HBW, Galea I, Cramer SP. Blood-brain barrier permeability measured using dynamic contrast-enhanced magnetic resonance imaging: a validation study. J Physiol 2019; 597 (03) 699-709
- 17 Starr JM, Farrall AJ, Armitage P, McGurn B, Wardlaw J. Blood-brain barrier permeability in Alzheimer’s disease: a case-control MRI study. Psychiatry Res 2009; 171 (03) 232-241
- 18 Haris M, Gupta RK, Singh A. et al. Differentiation of infective from neoplastic brain lesions by dynamic contrast-enhanced MRI. Neuroradiology 2008; 50 (06) 531-540
- 19 Ghosh RN, Vyas S, Singh P, Khandelwal N, Sankhyan N, Singhi P. Perfusion magnetic resonance imaging in differentiation of neurocysticercosis and tuberculoma. Neuroradiology 2019; 61 (03) 257-263
- 20 Singh A, Haris M, Rathore D. et al. Quantification of physiological and hemodynamic indices using T(1) dynamic contrast-enhanced MRI in intracranial mass lesions. J Magn Reson Imaging 2007; 26 (04) 871-880
- 21 van der Flier M, Hoppenreijs S, van Rensburg AJ. et al. Vascular endothelial growth factor and blood-brain barrier disruption in tuberculous meningitis. Pediatr Infect Dis J 2004; 23 (07) 608-613