Assessment of therapeutic response in brain tuberculomas using serial dynamic contrast-enhanced MRI

AimTo assess the most useful dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) index in the evaluation of the therapeutic response in brain tuberculoma (BT) patients.Subjects and methodsTwenty-three patients with 25 BT lesions were serially evaluated using DCE MRI. All lesions were classified into two groups: group I (n = 15) included patients who showed clinical, as well as imaging, improvement; and group II (n = 10) included patients with either clinical or radiological deterioration. The group I and group II lesions were examined for up to 12 months at 4 monthly intervals. However, the lesions in five patients of group II were excised following clinical deterioration after 4 months of therapy. The perfusion indices, i.e., relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), permeability (ktrans), and leakage (ve), were quantified at each time point. The cellular, necrotic, and total volumes of lesion, together with the oedema volume, were also calculated.ResultsAll patients in group I and three in group II showed a significant decrease in all perfusion indices, together with the oedema volume, after 1 year. In these three patients in group II, increase in rCBV was associated with increased cellular volume fraction whereas the ktrans, ve, and oedema volume decreased significantly after 4 months. In five patients in group II who underwent excision of the lesion after 4 months of therapy due to clinical deterioration, the decrease in rCBV was associated with significant increase in ktrans and oedema volume without any significant change in lesion volume. The rCBV correlated significantly with the cellular volume, whereas ktrans showed a significant correlation with the ve and oedema volume at each time point.ConclusionIn BT, changes in ktrans and oedema volume are associated with a therapeutic response at 4 months, even when there is a paradoxical increase in the lesion volume.