A Study of Brain Metastases and Tuberculomas Examination Using MRS and DWI | [Pakistan Journal of Neurological Surgery • 2024]

Author(s):

1. Atif Maqsood: Department of Neurology, Aziz Fatimah Medical and Dental College,Faisalabad,Pakistan

2. Faizan Aslam: Department of Neurology, Aziz Fatimah Medical and Dental College,Faisalabad,Pakistan

3. Muhammad Absar Alam: Department of Neurology, Aziz Fatimah Medical and Dental College,Faisalabad,,Pakistan

4. Mubarak Ali Anjum: Department of Neurology, Aziz Fatimah Medical and Dental College,Faisalabad, ,Pakistan

5. Nadia Zulfiqar: Department of Neurology, Aziz Fatimah Medical and Dental College,Faisalabad,Pakistan

6. Muhammad Asif Javed: Department of Medicine, Abwa Medical College,Faisalabad , Pakistan

Abstract:

Objective: The present comparative study evaluates brain tuberculomas and metastasis using a combined analysis of MRS and DWI in the Pakistan context. Materials & Methods: The present comparative study was conducted at the Department of Neurology, Aziz Fatimah Medical and Dental College Faisalabad, Pakistan. This comparative prospective analysis also included 118 newly diagnosed, untreated individuals who were suspected or confirmed to have nervous system tuberculosis (NST) using sophisticated MRI methods such as DWI and MRS. Linear regression was utilized to compare tuberculomas based on the apparent diffusion coefficient value of high-grade gliomas and metastatic lesions. Results: Tuberculomas displayed predominantly isointense (61%) and hypointense (58.3%) signals on T1W and T2W images, respectively. Metastases showed a higher occurrence of T2 hyperintensity (61.6%) and T1 hyp0intensity (46.2%). Neurocysticercosis consistently appeared hypointense and hyperintense across all imaging modalities. High-grade gliomas were primarily hypointense on T1W (60%) & hyperintense on T2W (100%) images. Abscesses were uniformly hyperintense on T2W images. Mean ADC values were highest in neurocysticercosis (1.64 × 10?³ mm²/s) and lowest in abscesses (0.396 × 10?³ mm²/s). MRS revealed distinctive metabolite ratios, with high NAA/Cr & NAA/Ch0 in neurocysticercosis and elevated Ch0/Cr in high-grade gliomas. Conclusion: There is no discernible benefit to using DWI to distinguish tuberculomas from gliomas and metastases. It is possible to distinguish tuberculomas from gliomas and metastases using their distinct metabolite pattern on MRS.

Page(s): 340-349

DOI: 10.36552/pjns.v28i3.1006

Published: Journal: Pakistan Journal of Neurological Surgery, Volume: 28, Issue: 3, Year: 2024

Keywords:

Metastasis , Combined Analysis , Brain Tuberculomas , DWI Diffusion Weight Imaging , MRS Magnetic Resonance Spectroscopy

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